Disease Prevention: Data Integration

In his Perspective “Why a macroeconomic perspective is critical to the prevention of noncommunicable disease” (special section on Disease Prevention, 21 September, p. [1501][1]), R. Smith fails to acknowledge a fundamental flaw in the design of the delivery of health care: the lack of data integration among each patient's disparate health records. This structural issue in the healthcare system must be addressed in order to optimize preventive care. For example, research shows a relationship between diabetes and periodontal disease ([ 1 ][2], [ 2 ][3]). However, the National Committee for Quality Assurance (NCQA) was established by medical health plans that do not typically serve as payers for dental care. It is therefore difficult for the NCQA to require a periodontal screening of diabetes patients as part of a Health Effectiveness Data and Information Set measure, despite the importance of this measure according to the Wisconsin Diabetes Prevention and Control Program Guidelines ([ 3 ][4]). Furthermore, most private-sector electronic health records technologies fail to integrate medical and dental records. The lack of integrated data hinders the efforts of researchers trying to address the relationships between periodontal disease and diabetes. It also places a technical barrier in the path of disease registries set up to monitor the quality of preventive care delivered by medical home provider teams. The data about a given patient's medical and dental care are only available in separate claim streams and usually cannot be successfully integrated, given disparate and unarticulated patient identification schemes ([ 4 ][5]). Revising the model of care delivery would affect provider education, the structure and function of healthcare organizations, the design of electronic records systems and health information exchanges, models for quality assurance and meaningful use, and models and operations for payer organizations. True preventive care must be adequately integrated, and provider utilization must be optimized. Before undertaking macroeconomic remedies, let us first address the models of care delivery and patient records. 1. [↵][6] 1. B. L. Mealey, 2. L. F. Rose , Curr. Opin. Endocrinol., Diabetes Obesity 15, 135 (2008). [OpenUrl][7][CrossRef][8] 2. [↵][9] 1. G. W. Taylor, 2. W. S. Borgnakke , Oral Dis. 14, 191 (2008). [OpenUrl][10][CrossRef][11][PubMed][12][Web of Science][13] 3. [↵][14] Wisconsin Diabetes Advisory Group, Wisconsin essential diabetes mellitus care guidelines (Wisconsin Diabetes Prevention and Control Program, Madison, WI, 2008), chap. 9; . 4. [↵][15] S. Foreman, in Integration of Medical and Dental Care and Patient Data , V. Powell et al ., Eds., (Springer-Verlag, London, 2012), chap. 4.1. [1]: /lookup/doi/10.1126/science.1222569 [2]: #ref-1 [3]: #ref-2 [4]: #ref-3 [5]: #ref-4 [6]: #xref-ref-1-1 "View reference 1 in text" [7]: {openurl}?query=rft.jtitle%253DCurr.%2BOpin.%2BEndocrinol.%252C%2BDiabetes%2BObesity%26rft.volume%253D15%26rft.spage%253D135%26rft_id%253Dinfo%253Adoi%252F10.1097%252FMED.0b013e3282f824b7%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [8]: /lookup/external-ref?access_num=10.1097/MED.0b013e3282f824b7&link_type=DOI [9]: #xref-ref-2-1 "View reference 2 in text" [10]: {openurl}?query=rft.jtitle%253DOral%2Bdiseases%26rft.stitle%253DOral%2BDis%26rft.aulast%253DTaylor%26rft.auinit1%253DG.%2BW.%26rft.volume%253D14%26rft.issue%253D3%26rft.spage%253D191%26rft.epage%253D203%26rft.atitle%253DPeriodontal%2Bdisease%253A%2Bassociations%2Bwith%2Bdiabetes%252C%2Bglycemic%2Bcontrol%2Band%2Bcomplications.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1601-0825.2008.01442.x%26rft_id%253Dinfo%253Apmid%252F18336370%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [11]: /lookup/external-ref?access_num=10.1111/j.1601-0825.2008.01442.x&link_type=DOI [12]: /lookup/external-ref?access_num=18336370&link_type=MED&atom=%2Fsci%2F338%2F6112%2F1285.2.atom [13]: /lookup/external-ref?access_num=000253980800001&link_type=ISI [14]: #xref-ref-3-1 "View reference 3 in text" [15]: #xref-ref-4-1 "View reference 4 in text"