A Quality Management Program in Dental Care Practices
A Quality Management Program in Dental Care Practices
Improving the quality of healthcare is a high priority in Western health care systems driven by factors such as reducing adverse events, optimizing efficiency, and enhancing patient satisfaction. An excellent definition of quality in healthcare is given by Mills & Batchelor. In essence, however, quality of care can been defined and evaluated in terms of structure, process and outcomes. Whilst the presence of specific organizational structures does not necessarily result in better clinical processes and outcomes, organizational aspects are certainly enablers of higher performance. Little is known about how to improve quality of organizational aspects of primary sector dental care. The majority of literature and the evidence base for defining and measuring quality in primary care come from general medical practice and not from oral health care settings. However, assessing and monitoring the quality of dental care play an important role in quality assurance and quality improvement.
In most health care systems, a variety of quality improvement initiatives have been implemented to enhance both health care management broadly speaking and dental health care specifically speaking. For instance, in the United Kingdom quality indicators were developed for the new National Health Service (NHS) dental contract which targets measuring the quality of patient care as well as performance. In 2005, in Scotland, the "Action Plan for Improving Oral Health and Modernising NHS Dental Services" was announced. Since 1997, in the United States, an assessment instrument developed and initiated by MetLife has been implemented for dental care providers. Particularly countries such as the United Kingdom, the United States and Canada have shown expertise in development and implementation of quality management systems. Quality management means quality assurance: the systematic measurement and monitoring of process, structure and outcome of care and results in a continuous improvement process. For example, the plan-do-study-act cycle, to ensure quality of care. In 2006, the German government stipulated that general dental practitioners should implement a system of annual assessment of quality management, in the same way that general medical practices are expected to do. Although, to date, there are no formal sanctions, so participation remains voluntary. The result has been that different quality management systems have become available for health care providers in primary care settings. These different quality management systems measure structure and process of care as well as non-clinical outcomes of patients.
However, while such quality management programs are available for dental care, evidence on their impact and effectiveness is sparse, with some exceptions. There is an urgent need for validated quality assessment tools for dental care. The European Practice Assessment is a comprehensive, integrative and multifaceted tool for quality assessment and quality improvement in health care in terms of quality management. It is based on quality indicators developed for use in primary medical care settings to evaluate the structure and process of care. The European Practice Assessment tool has shown effectiveness in improving the management of general medical practices. The current study focuses on the implementation and repeated measurement of European Practice Assessment tool in primary dental care settings and examined whether improvements occurred in dental care practice that completed the European Practice Assessment twice compared with dental care practices that completed the European Practice Assessment once.
Background
Improving the quality of healthcare is a high priority in Western health care systems driven by factors such as reducing adverse events, optimizing efficiency, and enhancing patient satisfaction. An excellent definition of quality in healthcare is given by Mills & Batchelor. In essence, however, quality of care can been defined and evaluated in terms of structure, process and outcomes. Whilst the presence of specific organizational structures does not necessarily result in better clinical processes and outcomes, organizational aspects are certainly enablers of higher performance. Little is known about how to improve quality of organizational aspects of primary sector dental care. The majority of literature and the evidence base for defining and measuring quality in primary care come from general medical practice and not from oral health care settings. However, assessing and monitoring the quality of dental care play an important role in quality assurance and quality improvement.
In most health care systems, a variety of quality improvement initiatives have been implemented to enhance both health care management broadly speaking and dental health care specifically speaking. For instance, in the United Kingdom quality indicators were developed for the new National Health Service (NHS) dental contract which targets measuring the quality of patient care as well as performance. In 2005, in Scotland, the "Action Plan for Improving Oral Health and Modernising NHS Dental Services" was announced. Since 1997, in the United States, an assessment instrument developed and initiated by MetLife has been implemented for dental care providers. Particularly countries such as the United Kingdom, the United States and Canada have shown expertise in development and implementation of quality management systems. Quality management means quality assurance: the systematic measurement and monitoring of process, structure and outcome of care and results in a continuous improvement process. For example, the plan-do-study-act cycle, to ensure quality of care. In 2006, the German government stipulated that general dental practitioners should implement a system of annual assessment of quality management, in the same way that general medical practices are expected to do. Although, to date, there are no formal sanctions, so participation remains voluntary. The result has been that different quality management systems have become available for health care providers in primary care settings. These different quality management systems measure structure and process of care as well as non-clinical outcomes of patients.
However, while such quality management programs are available for dental care, evidence on their impact and effectiveness is sparse, with some exceptions. There is an urgent need for validated quality assessment tools for dental care. The European Practice Assessment is a comprehensive, integrative and multifaceted tool for quality assessment and quality improvement in health care in terms of quality management. It is based on quality indicators developed for use in primary medical care settings to evaluate the structure and process of care. The European Practice Assessment tool has shown effectiveness in improving the management of general medical practices. The current study focuses on the implementation and repeated measurement of European Practice Assessment tool in primary dental care settings and examined whether improvements occurred in dental care practice that completed the European Practice Assessment twice compared with dental care practices that completed the European Practice Assessment once.
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