Developing computerized decision support for intersectoral care of chronic-systemic and oral conditions


Limitations in intersectoral care have been the topic of science and health policies for many years. There is still considerable potential for improvement in this regard. Against the background of growing complexity due to the growing amount of information, increasing availability of health care data (e.g. electronic health records or administrative insurance data) and developments towards an increasingly patient-centered care, the question arises what are suitable strategies and methods for sustainable intensification of intersectoral care.
Particularly, there is considerable potential for improvement in inter-professional cooperation between general medicine and dental medicine. Dent@Prevent approaches this issue from the perspective that the use of modern information systems can contribute to this.

Dent@Prevent is based on the premise that an intensified intersectoral cooperation of general medicine and dental medicine leads to improved quality and resource allocation in health care.
However, a joint approach to general health and oral health in Germany has so far only received little attention, although extensive empirical evidence indicates associations between dental diseases (in particular periodontal disease) and diabetes, coronary heart disease and stroke, as well as common risk factors.
An integrated approach is likely to be preferred by patients, which may further contribute to favorable outcomes in dental and general health care. The project aims to implement up-to-date knowledge, routine data and Patient-Reported Measures (PRMs) in an electronic information system, suitable for the promotion of intersectoral collaboration.
We aim to do this in an evidence-informed, and patient-centered way, focusing specifically on dental and general medical care. Below you will find a description of two of the studies that are part of Dent@Prevent, which are currently under development.

Dent@Prevent synthesis of evidence

A literature review is conducted to assess the current knowledge of:

  1. possible interrelationships between dental and chronic-systemic diseases
  2. possible intersectoral treatments for patients with dental or chronic-systemic diseases, as represented in dental and medical guidelines, and
  3. patient-reported measures (PRMs) for chronic-systemic and dental diseases.

In order to do this, existing systematic reviews and other key studies are reviewed in an umbrella review for interrelationships between dental and chronic-systemic diseases. For the interactions between discovered diseases, guidelines for general medicine and dental medicine in Germany are searched. Both of these sources about information on interrelations between oral and chronic-systemic diseases and guidelines are to be discussed with stakeholders (see below) and further refined or extended. In addition, a scoping search of patient-reported outcomes and measures addressing these for general health and oral health is conducted, and extended based on focus groups with patients (see below).  

Dent@Prevent early stakeholder engagement and focus groups

Using qualitative methods, this study aims to better understand interrelations between chronic-systemic and dental diseases, as well as possibilities of how intersectoral care can be improved and supported. In addition, it aims to involve end users in the development of (yet to be designed) information systems that will support inter-professional care.
In order to do so, focus groups will be conducted to better understand the perspectives of:

  1. experts with a background in (dental or medical) professional organizations and scientific research,
  2. dentists,
  3. general practitioners, and
  4. persons with a chronic-systemic conditions that interrelates with oral health.

In this part of the study, four central themes will be the basis for discussion in the focus groups:

  1. practice-based experiences with and recommendations for the care of persons with chronic-systemic and oral conditions, in oral health care and in general medicine, 
  2. current practices of and priorities for intersectoral care, in terms of daily health care decisions, diseases and interrelations between diseases need to be addressed,
  3. participant´s needs for support, knowledge, or recommendations regarding oral-systemic disease interactions, and
  4. patient-reported measures which are useful for decision-making at the intersect between chronic-systemic and oral health care.

The Consortium