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Report cites quality improvement efforts, opportunities

January 26, 2012

By Craig Palmer

Washington—Quality improvement efforts in organized dentistry and throughout the health care system offer opportunities to increase access to care and "improve and maintain the oral health of the U.S. population," says a report funded by the W.K. Kellogg Foundation and DentaQuest Institute and intended to advance the national health policy dialogue.

Although quality improvement in oral health lags behind similar efforts for overall health, these efforts are intensifying, says the report, Oral Health Quality Improvement in the Era of Accountability, which was prepared by Dr. Paul Glassman, professor of dental practice, director of community oral health and director of the Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry, and released Jan. 26.

"This report effectively points out current transformations occurring in general health care and advocates that dentistry must become actively involved," said Dr. Albert Guay, one of two American Dental Association representatives acknowledged by the author for "perspective provided" as contributors to the report from various oral health care vantage points.

"The Association is active in most of the areas mentioned in the report, most notably in the formation of the Dental Quality Alliance with other stakeholders, development of the SNODENT (Systemized Nomenclature of Dentistry) diagnostic coding system, participation in standards development for electronic health records and encouraging the early involvement of physicians in the dental care system for infants and young children," said Dr. Guay, ADA chief policy adviser when the report was written and now chief policy adviser emeritus.

"Dentists have long been interested in dental practice efficiency to increase the availability of care. Delegation of suitable duties to ancillary personnel under dentist supervision and the development of new categories of ancillary personnel have significantly increased office efficiency. In determining what procedures can be delegated to which ancillary personnel, patient safety and the quality of care provided has been the overriding concern," said Dr. Guay. Dr. David Preble, director of the ADA Council on Dental Benefits, is also listed among 11 report contributors.

The report also refers to "changes called for" by the Institute of Medicine in 2011.

"Even with increasing activity by many groups that are developing and using measures of oral health quality, current activities to spread the use of these measures and to improve quality in oral health care are still in their infancy," the report says. "Oral health measures are not in widespread use, they are generally voluntary and not tied to consequences for poor performance, and they tend to emphasize the lowest levels of quality measurement and quality assurance.

"There are few examples of robust quality improvement programs directed at measuring oral health outcomes of the population being served and incentivizing providers to alter their activities to improve those outcomes. In addition, although there is compelling evidence that there are significant oral health disparities based on race, ethnicity, socio-economic status and disability, there are few measures of oral health performance tied to these issues and even fewer that provide incentives for providers of oral health care to do anything differently.

"However, in spite of the fact that quality improvement systems in oral health are not well developed or in general use, and the fact that there are many barriers to change, there are opportunities for improvement as oral health care becomes more accountable," the report concludes.

The W.K. Kellogg Foundation, founded in 1930 by breakfast cereal pioneer Will Keith Kellogg, is among the largest philanthropic foundations in the United States. "With the current focus on quality improvement in health care, we need to make sure that oral health isn't left behind," said Alice Warner, the foundation's program director.

"The DentaQuest Institute is working closely with clinical partners to implement quality improvement strategies that emphasize prevention and disease management in dental care," said Dr. Mark Doherty, executive director.