title: Tooth retention as an indicator of quality dental care: development of a risk adjustment model.
abstract: BACKGROUND
  Retaining teeth improves oral health and quality of life. Thus, receipt of a root canal (vs. a tooth extraction) is a useful indicator of the quality of dental care. However, use of this quality measure without adjusting for the severity of oral disease could lead to spurious conclusions.
  
  
  OBJECTIVE
  This paper describes the development of a dental severity adjustment methodology.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  54,423 users of Department of Veterans Affairs (VA) dental care who had either root canal therapy or a tooth extraction at a VA facility in Fiscal year 1998.
  
  
  METHODS
  International Classification of Disease Clinical Modification codes for dental diagnoses and comorbid medical conditions. We modeled the effects of dental disease severity in logistic regression models of the probability of receiving a root canal, using both conceptual and Modified Delphi-Panel derived models, adjusting for age, and medical comorbidities.
  
  
  RESULTS
  Conceptual and Modified Delphi models performed similarly. The dental disease severity adjustments increased the fit in models of the probability of receiving a root canal (C-statistic = 0.822 for the conceptual model and 0.804 for the Modified Delphi Panel model) compared with the model including comorbid medical conditions alone (C-statistic = 0.561).
  
  
  CONCLUSIONS
  Risk adjustment for dental disease severity improves the fit of models of the probability of receiving a root canal. Studies of the quality of dental care should consider employing risk-adjusted models.
authors.affiliation: VA Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital-Bedford, and Department of General Dentistry, Boston University School of Dental Medicine, Massachusetts, USA. judjones@bu.edu
authors.forename: Judith A
authors.initials: JA
authors.lastname: Jones
authors.forename: Ulrike
authors.initials: U
authors.lastname: Boehmer
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Christiansen
authors.forename: Arkadiy
authors.initials: A
authors.lastname: Pitman
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
mesh_terms: D000437:Alcoholism / Q000453:epidemiology; D015897:Comorbidity; D003729:Dental Care / Q000592:standards*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D020379:Risk Adjustment; D012390:Root Canal Therapy / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000453:epidemiology; D012720:Severity of Illness Index; D014081:Tooth Extraction / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs