Quality assurance in medicine: a dental audit system.
Two principal components of a quality assurance system for dental plans are described, using a case report to illustrate the methodology. Criteria of acceptable quality of patient care for general practice were developed first. Then plan, practice and patient profiles, derived from claims or encounter data, were used to identify the nature and extent of aberrant patterns which were uncovered. Based on analysis of the profiles, site visits were made to a targeted sample of practices and selected patient dental records were evaluated for various levels of the process of care. Categories were rated as either acceptable or unacceptable. Principal dentists were debriefed on the findings and a report including corrective action plans prepared for the responsible agency. Follow-up to monitor compliance is planned. Although aberrant profiles do not necessarily mean that care is unacceptable, the findings from the record review confirmed the concerns raised by the data analysis.
Schoen
M H
MH
UCLA School of Dentistry.
Marcus
M
M
D002204:Capitation Fee; D003625:Data Collection / Q000379:methods; D003729:Dental Care / Q000592:standards*; D003792:Dental Records; D005250:Fees, Dental; D006264:Health Benefit Plans, Employee; D006302:Health Services Research; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D007347:Insurance, Dental; D008485:Medical Audit / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D011243:Preferred Provider Organizations; D011785:Quality Assurance, Health Care / Q000458:organization & administration*