Children Who Have Dental Decay or Cavities

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.

These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Children who have dental decay or cavities are less likely to be in very good or excellent overall health than children without decay or cavities. Children with decay are also more likely to have other oral health problems such as toothaches, broken teeth, and bleeding gums.

Milgrom P, Zero DT, Tanzer JM. An examination of the advances in science and technology of prevention of tooth decay in young children since the Surgeon General's Report on Oral Health. Acad Pediatr. 2009;9(6):404-409.

Table of Contents

Initial Patient Population =
- AND: "Patient Characteristic Birthdate: birth date" >= 0 year(s) starts before start of "Measurement Period"
- AND: "Patient Characteristic Birthdate: birth date" < 20 year(s) starts before start of "Measurement Period"
- AND:
  - OR: "Encounter, Performed: Face-to-Face Interaction"
  - OR: "Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17"
  - OR: "Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17"
  - OR: "Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up"
  - OR: "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up"
  - OR: "Encounter, Performed: Office Visit"
  - OR: "Encounter, Performed: Clinical Oral Evaluation"
  - during "Measurement Period"
Denominator =
- AND: "Initial Patient Population"
Denominator Exclusions =
- None
Numerator =
- AND NOT: "Occurrence A of Diagnosis, Active: Dental Caries" ends before start of "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Dental Caries" starts before or during "Measurement Period"
Denominator Exceptions =
- None

Data criteria (QDM Data Elements)

"Diagnosis, Active: Dental Caries" using "Dental Caries Grouping Value Set (2.16.840.1.113883.3.464.1003.125.12.1004)"
"Encounter, Performed: Clinical Oral Evaluation" using "Clinical Oral Evaluation Grouping Value Set (2.16.840.1.113883.3.464.1003.125.12.1003)"
"Encounter, Performed: Face-to-Face Interaction" using "Face-to-Face Interaction Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1048)"
"Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17" using "Preventive Care - Established Office Visit, 0 to 17 Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1024)"
"Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" using "Preventive Care Services - Established Office Visit, 18 and Up Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1025)"
"Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up" using "Preventive Care Services-Initial Office Visit, 18 and Up Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1023)"
"Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17" using "Preventive Care- Initial Office Visit, 0 to 17 Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1022)"
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"

Reporting Stratification

None

Supplemental Data Elements

"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeSex Value Set (2.16.840.1.113762.1.4.1)"

Measure Set

Not applicable

eMeasure Title	Children Who Have Dental Decay or Cavities
eMeasure Identifier (Measure Authoring Tool)	75	eMeasure Version number	3
NQF Number	Not Applicable	GUID	61947125-4376-4a7b-ab7a-ac2be9bd9138
Measurement Period	January 1, 20xx through December 31, 20xx
Measure Steward	Centers for Medicare & Medicaid Services
Measure Developer	National Committee for Quality Assurance
Endorsed By	None
Description	Percentage of children, age 0-20 years, who have had tooth decay or cavities during the measurement period.
Copyright	Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.
Disclaimer	These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring	Proportion
Measure Type	Outcome
Stratification	None
Risk Adjustment	None
Rate Aggregation	None
Rationale	Dental cavities have been identified as the most common chronic disease for children. Nationally, 19.4% of children have dental decay or cavities.
Clinical Recommendation Statement	Children who have dental decay or cavities are less likely to be in very good or excellent overall health than children without decay or cavities. Children with decay are also more likely to have other oral health problems such as toothaches, broken teeth, and bleeding gums.
Improvement Notation	A lower score indicates better quality
Reference	Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health, Data Resource Center for Child Adolescent Health website. www.nschdata.org
Reference	Edelstein BL, Chinn CH. Update on disparities in oral health and access to dental care for America's children. Acad Pediatr.2009;9(6):415-419.
Reference	Milgrom P, Zero DT, Tanzer JM. An examination of the advances in science and technology of prevention of tooth decay in young children since the Surgeon General's Report on Oral Health. Acad Pediatr. 2009;9(6):404-409.
Definition	None
Guidance	None
Transmission Format	TBD
Initial Patient Population	Children, age 0-20 years, with a visit during the measurement period.
Denominator	Equals initial patient population
Denominator Exclusions	None
Numerator	Children who had cavities or decayed teeth.
Numerator Exclusions	Not applicable
Denominator Exceptions	None
Measure Population	Not applicable
Measure Observations	Not applicable
Supplemental Data Elements	For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents

Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements