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ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2012 Conference Abstracts

Use of Syndromic Data to Determine Oral Health Visit
Burden on Emergency Departments
Howard Burkom*1, Sherry Burrer1, Laurie Barker3, Valerie Robison3, Peter Hicks1 and Amy
Ising2

1CDC, OSELS, Public Health Surveillance Program Office, Atlanta, GA, USA; 2University of North Carolina Department of Emergency
Medicine, Chapel Hill, NC, USA; 3CDC, NCCDPHP, Div. of Oral Health, Atlanta, GA, USA

Objective
The objective was to use syndromic surveillance data from the

North Carolina Disease Event Tracking and Epidemiologic Collec-
tion Tool NCDETECT and from BioSense to quantify the burden on
North Carolina (NC) emergency departments of oral health-related
visits more appropriate for care in a dental office (ED). Calculations
were sought in terms of the Medicaid-covered visit rate relative to
the Medicaid-eligible population by age group and by county.

Introduction
Concern over oral health-related ED visits stems from the in-

creasing number of unemployed and uninsured, the cost burden of
these visits, and the unavailability of indicated dental care in EDs [1].
Of particular interest to NC state public health planners are Medi-
caid-covered visits. Syndromic data in biosurveillance systems offer
a means to quantify these visits overall and by county and age group.

Methods
Using BioSense data received from NCDETECT, 60.8 million

records from 12.9 million ED visits were collected, covering all NC
visits for state fiscal years (SFY) 2008-2010. Roughly 4% of visits
were dropped because of patient residence zip codes missing or out-
side NC. A careful multi-step procedure involving both dentist con-
sultants and data analysis was used to derive classification criteria
for visits whose main reason was a nontraumatic oral health problem
[2]. This procedure yielded 243,970 visits by ~174,600 patients based
on hospital-specific patient identifiers. Nontraumatic oral health-re-
lated visits were collected in a study set with added fields for method
of payment, patient residence county, and age group. Based on pre-
vious studies, consultant preferences, and NC Medicaid eligibility
guidelines, selected age groups were 0-14, 15-19, 20-29, 30-49, 50+
years. Stratified counts of Medicaid-eligibles were obtained from the
NC Dental Director by study year. Using these tables and the ED visit
study set, rates of nontraumatic oral health-related Medicaid visits
per 10,000 eligibles were tabulated by county and age group for each
study year. Demographics of multiple-visit patients were also studied.

Results
Rates of ED oral health-related visits were substantially higher for

young adults than for other age groups. From statewide rates in Table
1, this age factor was consistent across study years.

County-level rates showed the same age pattern to varying degrees.
Detailed analysis showed problem areas, with rates in 21 of 100 coun-
ties exceeding 60 per 10,000 eligibles for the 20-29 year age group.
Plots and tables complemented understanding of the ED oral health
visit burden by age and county. The state total ED burden for oral
health problems was ~2% (0.2% - 9.7% by county).

Conclusions
Judicious use of syndromic data with external information, such as

the detailed Medicaid denominators and the Method of Payment
codes for each visit above, can give quantified estimates for policy-
related public health issues. In the current study, the derived oral
health visit rates gave numerical detail to concerns about the use of
NC EDs for nontraumatic oral health problems by low-income per-
sons affected by the economic recession. Results also show rate vari-
ation by county and can be combined with access-to-care data to
inform planning of effective local measures to improve access to den-
tal services and thus reduce the ED visit burden.

Table 1. NC Statewide Oral Health Medicaid Visits to Emergency Departments
per 10,000 Eligibles

Keywords
emergency department; chief complaint; BioSense; oral health;
NCDETECT

Acknowledgments

Mark Casey, North Carolina Dental Director for Medicaid eligibility and
care provider data; Chris Okunseri, Marquette University for case defi-
nition advice; Lana Deyneka of the North Carolina Department of Health
and Human Services for consultation; Dennis Falls of NCDETECT for
Method of Payment information.

References

1. Shortridge, E. and Moore, J. 2010. “Use of Emergency Departments for
Conditions related to Poor Oral Health Care.” Final Report. Wash-
ington, DC: Office of Rural Health Policy. August 2010.

2. Burrer S, Burkom H, Okunseri C, Barker L, Robison V, Nontraumatic
Oral Health Classification developed from Syndromic Data, Abstract,
International Society of Disease Surveillance Conference 2012.

*Howard Burkom
E-mail: howard.burkom@jhuapl.edu

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e57, 2013