title: Strategic Shift to a Diagnostic Model of Care in a Multi-Site Group Dental Practice.
abstract: BACKGROUND
  Documenting standardized dental diagnostic terms represents an emerging change for how dentistry is practiced. We focused on a mid-sized dental group practice as it shifted to a policy of documenting patients' diagnoses using standardized terms in the electronic health record.
  
  
  METHODS
  Kotter's change framework was translated into interview questions posed to the senior leadership in a mid-size dental group practice. In addition, quantitative content analyses were conducted on the written policies and forms before and after the implementation of standardized diagnosis documentation to assess the extent to which the forms and policies reflected the shift. Three reviewers analyzed the data individually and reached consensuses where needed.
  
  
  RESULTS
  Kotter's guiding change framework explained the steps taken to 97 percent utilization rate of the Electronic Health Record and Dental Diagnostic Code. Of the 96 documents included in the forms and policy analysis, 31 documents were officially updated but only two added a diagnostic element.
  
  
  CONCLUSIONS
  Change strategies established in the business literature hold utility for dental practices seeking diagnosis-centered care.
  
  
  CONCLUSIONS
  A practice that shifts to a diagnosis-driven care philosophy would be best served by ensuring that the change process follows a leadership framework that is calibrated to the organization's culture.
authors.affiliation: Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Kalenderian
authors.affiliation: Simmons School of Social Work, Boston, MA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Maramaldi
authors.affiliation: Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Etolue
authors.affiliation: Willamette Dental Group, Hillsboro, OR, USA.
authors.forename: L
authors.initials: L
authors.lastname: McClellan
authors.affiliation: Willamette Dental Group, Hillsboro, OR, USA.
authors.forename: K
authors.initials: K
authors.lastname: Simmons
authors.affiliation: Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Yansane
authors.affiliation: Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: White
authors.affiliation: Department of Diagnostic and Biomedical Sciences, The University of Texas Health Science Center at Houston, School of Dentistry, Houston, Texas, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Walji
authors.affiliation: Center for Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Ramoni
keywords: Dentistry; Diagnosis; Forms; Framework; Leadership; Policies; Vision