A performance measurement plan for pediatric dentists: using accuracy of caries diagnosis from intraoral radiographs

The purpose of this study was to develop a metric for measuring (1) an individual pediatric dentist's performance against peer performance and (2) aggregate group performance, using accuracy of caries diagnosis.

A total of 3,985 tooth surfaces (from 174 patients) on intraoral bitewing radiographs were assessed by 9 precalibrated attending pediatric dentists at Children's Hospital Boston over a 3-year period. Each surface was reviewed by 3 pediatric dentists (the operating dentist and 2 peer reviewers) using a score card. An accurate diagnosis was defined as agreement between the operating dentist and at least 1 peer reviewer as to the presence or absence of caries.

Average percentage diagnostic accuracy within the group over the course of the project was approximately 95% (95% confidence interval=94.0-95.4). Individual dentist scores ranged from approximately 89% to 96%. Group average rose steadily over time, from approximately 93% in 2008 to 97% by 2010. Unacceptable diagnosis (∼5% of surfaces assessed) did not directly translate into unfavorable treatment (∼4% of surfaces with unacceptable diagnosis).

Interexaminer reliability as a proxy for accuracy of caries diagnoses from bitewing radiographs is a viable metric for improving and assessing the quality of care provided by pediatric dentists.