title: Ensuring head and neck oncology patients receive recommended pretreatment dental evaluations.
abstract: OBJECTIVE
  Head and neck (H&N) cancer therapy can have a detrimental effect on oral health by increasing the risk of dry mouth, dental caries, dental infection, and osteonecrosis of the jaw. Pretreatment dental evaluations are recommended for patients with H&N cancer before radiation therapy to minimize the risk of acute and long-term adverse effects. In an earlier effort to educate patients and community dentists about the importance of pretreatment dental evaluations, we created a dental instructional guide (DIG) that outlines the necessary components of the preradiation dental evaluation. Yet our program did not have a system for documenting which patients received the DIG. The aim of this project was to create a reliable system to ensure that patients are given the DIG before radiation therapy and that such patients are readily identifiable, allowing us to confirm that their dental evaluations are complete before starting treatment.
  
  
  METHODS
  We implemented a tracking template within the H&N oncology program at the Dana-Farber Cancer Institute that documents the date, patient, and clinician who gave the DIG. We used the Model for Improvement methodology and performed plan-do-study-act (PDSA) cycles to test and monitor the results of the template implementation.
  
  
  RESULTS
  We showed a significant improvement in the rate of DIG documentation from a baseline of 0% (range, 0% to 0%) to a mean of 53% (range, 0% to 100%) over 3 months (P < .01).
  
  
  CONCLUSIONS
  This intervention was the first step in creating a sustainable system for ensuring timely preradiation dental evaluation, thereby decreasing the risk of dental complications from H&N cancer therapy.
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY dmargalit@lroc.harvard.edu.
authors: Danielle N
authors: DN
authors: Margalit
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Stephanie M
authors: SM
authors: Losi
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Roy B
authors: RB
authors: Tishler
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Jonathan D
authors: JD
authors: Schoenfeld
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Jo
authors: J
authors: Ann Fugazzotto
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Josie
authors: J
authors: Stephens
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Amy L
authors: AL
authors: Cebulski
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Elizabeth L
authors: EL
authors: Hammerstrand
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Laura
authors: L
authors: Ma
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Holly M
authors: HM
authors: Lopes
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Robert I
authors: RI
authors: Haddad
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Nathaniel S
authors: NS
authors: Treister
authors: Brigham and Women's Hospital; Dana-Farber Cancer Institute; Center for Clinical Excellence, Brigham and Women's Hospital, Boston, MA; and Center for Oncology Care at Erie County Medical Center, Buffalo, NY.
authors: Jennifer L
authors: JL
authors: Frustino
mesh_terms: D004282:Documentation; D057286:Electronic Health Records; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D010353:Patient Education as Topic; D014076:Tooth Diseases / Q000517:prevention & control*