Highlights
- For more than a decade, Nebraskans have increasingly sought dental care in emergency departments (EDs) instead of receiving less costly care in a dentist's office.
- Epidemiologists with the Nebraska Department of Health and Human Services searched ED data to learn more about the reasons for these visits.
- ED use for non-traumatic dental conditions is widespread, economically burdening Nebraska. Findings will help ensure that people can receive routine dental care outside an ED.
Public health problem
For more than a decade, some Nebraskans have used emergency departments (EDs) for treatment of non-traumatic dental conditions instead of receiving less costly care in a dentist's office. In Nebraska, 52 of 93 counties have a shortage of dental care facilities and at least 20 counties lack full-time dentists. A study based on 2009–2016 Nebraska Hospital Discharge data shows an average of 7,982 visits for non-traumatic dental conditions per year. The average cost per emergency room visit for dental conditions increased from $712 in 2012 to $1,912 in 2018. Nebraska sought more information to develop a solution to this public health problem.
Actions taken
Because EDs in the states are required to report data to the Nebraska Department of Health and Human Services (DHHS), these data are readily available to search.
An oral health epidemiologist, with Nebraska DHHS, built an ESSENCE1 definition to identify non-traumatic dental conditions, patient demographics, and reasons for these visits. The query definition uses both:
- Discharge-diagnostic codes (based on Association of State and Territorial Dental Directors guidelines)
- Chief complaints (using primary search terms for dental terminology)
To assess the thoroughness and quality of the definition, epidemiologists manually reviewed 500 random records matching the definition. Then they categorized those records as related, unclear, or unrelated to non-traumatic dental conditions. Additionally, they studied Nebraska ED records reports, representing 40% of total Nebraska EDs.
Outcome
After applying the definition to examine Nebraska ED data, oral health epidemiologists identified 10,433 visits to EDs from January 2017 through December 2018 that were potentially related to non-traumatic dental conditions. On review, 85% were related to non-traumatic dental conditions, 12% were unclear, and 3% were unrelated. The highest percentage of ED visits for non-traumatic dental conditions was observed in females (55%), ages 26–45 years (47%), and urban residents (82%). Of the total ED visits (10,433) for non-traumatic dental conditions included in this study, about 93% of the patients were discharged home after their visits. The study results indicate that ED use for non-traumatic dental conditions is widespread and causing economic burden in Nebraska. Such findings are now being used to develop policies and interventions to ensure that people can receive access to dental care without going to EDs.
Resources
Dr. Charles F. Craft, Contact
State Dental Health Director
Nebraska Department of Health and Human Services
Email: Charles.Craft@nebraska.gov
Centers for Disease Control and Prevention
Office of Public Health Data, Surveillance, and Technology
Detect and Monitor Division
www.cdc.gov/nssp
We thank Pankti Parmar for writing this story. For more information, email Dr. Craft at Charles.Craft@nebraska.gov.
The findings and outcomes described in this syndromic success story are those of the authors and do not necessarily represent the official position of the National Syndromic Surveillance Program or the Centers for Disease Control and Prevention.
- ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) is the National Syndromic Surveillance Program's secure, web-based tool to operationalize the public health surveillance workflow. ESSENCE allows analysts, epidemiologists, and others across all levels of public health to collaborate, investigate changes in trends, and to analyze, visualize and share data.