Quality assessment as a form of continuing dental education: changing dentist clinical performance

A model for multidisciplinary peer review and supervision of behavioral health clinicians

The authors describe a semi-annual program for multidisciplinary peer review and supervision that is in use at two rural adult and child mental health and drug and alcohol service agencies. The program incorporates semiannual chart reviews and face-to-face discussions held with each clinician by a multidisciplinary supervisory group. Several quality improvement issues addressed by this program are described, including improved communication, improved clinical diagnosis, the establishment of service parameters, more appropriate referrals for psychiatric and other medical care, and improved clinician skills. The program represents an inexpensive approach to peer review and supervision that can incorporate university-based consultants, improve quality of care, improve clinicians' skills, and be readily applied by clinical supervisors to most behavioral health settings.

Educating dentists about fissure sealants: effects on knowledge, attitudes, and use

This study evaluated the effects of three modes of education on dentists' knowledge, attitudes, and use of pit and fissure sealants. A randomly selected group of dentists was invited to participate in a sealant education initiative. During a 12-month period, a total of 662 dentists either (1) attended continuing education courses, (2) received written materials and videotapes by mail, or (3) received only written materials by mail. A comparison group (n = 337) received no materials until after the education phase and evaluation had been completed. Pre- and postintervention surveys were used to measure changes in knowledge, attitudes, and sealant use. Response rates to the two surveys were 62 percent and 76 percent, respectively. Preintervention values for knowledge scores, an attitude scale, and sealant use were similar among the four groups. At followup, the three education groups had significantly higher knowledge scores than the comparison group. Attitude values for all but one group were not significantly different, and sealant use by all groups was identical. The numbers of respondents not using sealants declined slightly between surveys in the three education groups while rising slightly in the No-Education Group. Because program outcomes were similar to those of another sealant initiative, it can probably be concluded that continuing education will increase dentists' knowledge about sealants, but have little effect upon their attitudes or their use of the technique. The changes observed in this investigation may be due to the particular capacity for cognitive and affective changes of participants, characteristics of the technology being promoted, and external forces in the professional environment.

Measurement of oral status and treatment need among subjects with dental prostheses: are the measures less reliable than the prostheses? Part III: Fixed prosthodontics and restorative dentistry

Poor quality measures of oral status and treatment need have adversely affected clinical and epidemiologic research in prosthodontics. The failure to create reliable and valid indices prevents comparing and pooling data from different studies and obscures meaningful variation within individual studies. Part III of this literature review is focused on problems of measurement of restoration quality and need for treatment in the areas of fixed prosthodontics and restorative dentistry.

Training and calibrating evaluators for a national private dental office assessment program

The work described was conducted to train and calibrate ten general dentists to participate as evaluators in a national program in which methods were developed and tested for the in-office evaluation of private general dental practice. The methods used in conducting six days of initial training are described, as well as the approach taken in establishing the posttraining levels of individual and group calibration achieved. Training and calibration that occurred halfway through a two-year field experience also are described. Techniques employed included the use of slides in lecture format; review of records, radiographs, and other materials from dental offices; examination of patients; use of a videotaped simulation of an office visit; and evaluation of private dental offices by paired evaluators. Calculation of percent of comparability of evaluator performance was used in determining calibration levels. We concluded that evaluators can be trained in six days to achieve a high level of calibration. Additional benefits were derived from the additional training session at the midpoint of field activities. Evaluators perceived themselves to be well prepared as a result of the training described.

Evidence of the validity of a model of determinants of quality of restorative dental care

A model describing the relationship between self-reported quality of restorative dentistry and dentist characteristics for 119 Montana general dentists is presented. The best predictors formed a significant model explaining 22% of the variance of the quality measure. Results are contrasted with a previous estimation of the model for 102 Washington general practitioners. Evidence for the external validity of the model is presented.