Evaluation of audit-based performance measures for dental care plans.
OBJECTIVE
Although a set of clinical performance measures, i.e., a report card for dental plans, has been designed for use with administrative data, most plans do not have administrative data systems containing the data needed to calculate the measures. Therefore, we evaluated the use of a set of proxy clinical performance measures calculated from data obtained through chart audits.


METHODS
Chart audits were conducted in seven dental programs--three public health clinics, two dental health maintenance organizations (DHMO), and two preferred provider organizations (PPO). In all instances audits were completed by clinical staff who had been trained using telephone consultation and a self-instructional audit manual. The performance measures were calculated for the seven programs, audit reliability was assessed in four programs, and for one program the audit-based proxy measures were compared to the measures calculated using administrative data.


RESULTS
The audit-based measures were sensitive to known differences in program performance. The chart audit procedures yielded reasonably reliable data. However, missing data in patient charts rendered the calculation of some measures problematic--namely, caries and periodontal disease assessment and experience. Agreement between administrative and audit-based measures was good for most, but not all, measures in one program.


CONCLUSIONS
The audit-based proxy measures represent a complex but feasible approach to the calculation of performance measures for those programs lacking robust administrative data systems. However, until charts contain more complete diagnostic information (i.e., periodontal charting and diagnostic codes or reason-for-treatment codes), accurate determination of these aspects of clinical performance will be difficult.
Bader
J D
JD
Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. jim_bader@unc.edu
Shugars
D A
DA
White
B A
BA
Rindal
D B
DB
D000293:Adolescent; D000328:Adult; D019230:Dental Audit; D003729:Dental Care / Q000592:standards / Q000706:statistics & numerical data; D003731:Dental Caries / Q000145:classification / Q000517:prevention & control; D003740:Dental Clinics / Q000592:standards; D003777:Dental Prophylaxis / Q000592:standards / Q000706:statistics & numerical data; D003793:Dental Restoration, Permanent / Q000592:standards / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D006279:Health Maintenance Organizations / Q000592:standards; D006801:Humans; D007347:Insurance, Dental / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010510:Periodontal Diseases / Q000145:classification / Q000517:prevention & control; D011243:Preferred Provider Organizations / Q000592:standards; D011636:Public Health Dentistry / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014081:Tooth Extraction / Q000592:standards / Q000706:statistics & numerical data; D016388:Tooth Loss / Q000145:classification