title: A performance measurement plan for pediatric dentists: using accuracy of caries diagnosis from intraoral radiographs.
abstract: OBJECTIVE
  The purpose of this study was to develop a metric for measuring (1) an individual pediatric dentist's performance against peer performance and (2) aggregate group performance, using accuracy of caries diagnosis.
  
  
  METHODS
  A total of 3,985 tooth surfaces (from 174 patients) on intraoral bitewing radiographs were assessed by 9 precalibrated attending pediatric dentists at Children's Hospital Boston over a 3-year period. Each surface was reviewed by 3 pediatric dentists (the operating dentist and 2 peer reviewers) using a score card. An accurate diagnosis was defined as agreement between the operating dentist and at least 1 peer reviewer as to the presence or absence of caries.
  
  
  RESULTS
  Average percentage diagnostic accuracy within the group over the course of the project was approximately 95% (95% confidence interval=94.0-95.4). Individual dentist scores ranged from approximately 89% to 96%. Group average rose steadily over time, from approximately 93% in 2008 to 97% by 2010. Unacceptable diagnosis (∼5% of surfaces assessed) did not directly translate into unfavorable treatment (∼4% of surfaces with unacceptable diagnosis).
  
  
  CONCLUSIONS
  Interexaminer reliability as a proxy for accuracy of caries diagnoses from bitewing radiographs is a viable metric for improving and assessing the quality of care provided by pediatric dentists.
authors: Department of Dentistry, Children's Hospital Boston, Boston, Mass., USA.
authors: Henry O
authors: HO
authors: Ohiomoba
authors: Linda P
authors: LP
authors: Nelson
mesh_terms: D001641:Bicuspid / Q000000981:diagnostic imaging; D002138:Calibration; D002648:Child; D003481:Cuspid / Q000000981:diagnostic imaging; D003731:Dental Caries / Q000000981:diagnostic imaging*; D003743:Dental Enamel / Q000000981:diagnostic imaging; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D010377:Pediatric Dentistry / Q000592:standards*; D010379:Peer Group; D018024:Peer Review, Health Care; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D016300:Radiography, Bitewing / Q000706:statistics & numerical data*; D014094:Tooth, Deciduous / Q000000981:diagnostic imaging