COVID-19 RISK ASSESSMENT OF DENTAL SCHOOL PATIENTS FOR SAFE CLINICAL CARE STRATEGIES

OBJECTIVES: This quality improvement and safety project assessed the coronavirus disease 2019 (COVID-19) risk factors of the patient population at the University of Colorado School of Dental Medicine for the purpose of developing an operational strategy for modifying patient care protocols and clinic infrastructure during the pandemic. STUDY DESIGN: The data consist of retrospectively collected information on all patients treated at the University of Colorado School of Dental Medicine between March 1, 2019, and March 31, 2020, retrieved from the electronic dental health record. Variables of interest focused on patients treated by predoctoral students and included age group, race/ethnicity, and major comorbidities for COVID-19 risk. Patients were placed into 3 risk categories based on age and health status: Minimal (no comorbidities), high (comorbidities), and highest (>65 years and comorbidities). Descriptive statistics were calculated on the cohort. No hypothesis testing or statistical inference was employed. RESULTS: A total of 10,958 patients, with a median age of 53 (interquartile range, 34, 67) and equal sex distribution (F = 50%; M = 49.8%), treated by predoctoral students were identified. White, Hispanic, black, and mixed race accounted for 58.4%, 20.9%, 13.1%, and 2.2%, respectively. Regarding major comorbidities, 29.9% had 1, 14.8% had 2, and 9.1% had ≥3 (median = 1; interquartile range, 0, 1), with 53.5% of those ≥65 years having 3+ diseases. The most common comorbidities were cardiovascular disease (24.5%); diabetes (9.9%); immunocompromised, including HIV; and chronic corticosteroid use (9.5%), cancer (8.2%), and pulmonary disease (7.9%). The prevalence of tobacco smoking was 26.5%. Most patients were defined as high (30.9%) or highest (23%) risk, with 77.5% of those ≥75 years in the highest risk category. Stratifying by race/ethnicity, those with ≥1 comorbidities were distributed as follows: white = 62.3%, black = 56.8%, Hispanic = 40.4%, and mixed race = 64.4%. CONCLUSIONS: Most patients treated by predoctoral dental students in the main clinic were classified as high or highest risk for COVID-19 infection, and this risk increased with age. Information from this quality improvement project was critical for understanding the medical complexity of the patient pool and justifying major scheduling and infrastructure changes for safe delivery of clinical care in an academic environment.