A systematic review of quality measures used in primary care dentistry

Abstract

Introduction ‘Quality’ in primary care dentistry is poorly defined. There are significant international efforts focussed on developing quality measures within dentistry. The aim of this research was to identify measures used to assess quality in primary care dentistry and categorise them according to which dimensions of quality they attempt to measure. Methods Quality measures were identified from the peer‐reviewed and grey literature. Peer‐reviewed papers describing the development and validation of measures were identified using a structured literature search. Measures from the grey literature were identified using structured searches and direct contact with dental providers and institutions. Quality measures were categorised according to domains of structure, process and outcome and by disaggregated dimensions of quality. Results From 22 studies, 11 validated measure sets (comprising nine patient satisfaction surveys and two practice assessment instruments) were identified from the peer‐reviewed literature. From the grey literature, 24 measure sets, comprising 357 individual measures, were identified. Of these, 96 addressed structure, 174 addressed process and 87 addressed outcome. Only three of these 24 measure sets demonstrated evidence of validity testing. The identified measures failed to address dimensions of quality, such as efficiency and equity. Conclusions There has been a proliferation in the development of dental quality measures in recent years. However, this development has not been guided by a clear understanding of the meaning of quality. Few existing measures have undergone rigorous validity or reliability testing. A consensus is needed to establish a definition of quality in dentistry. Identification of the important dimension of quality in dentistry will allow for the production of a core quality measurement set.

Conceptualising a framework for improving quality in primary dental care

“…Recent reviews of the dental literature identify an ever-expanding growth in the number of quality indicators. 3,4 The majority of current indicators appear in the grey literature and have not been validated. The production of many of these indicators seems to be driven by requirements of service payers as part of a remuneration system or to performance manage aspects of service delivery.…”

“…Currently, data for measures are either generated though administrative claims, patient satisfaction surveys or practice inspection and audit. 4 There are limits to what data can be derived from administrative claims alone, and the vast array of different healthcare systems worldwide means that blanket application of measures would be difficult. The use of SNOMED, SNODDS and SNODENT diagnostic terminologies 31 may be a helpful first step towards this but widespread adoption of these systems is problematic.…”

“…Validated quality measures are vital for comprehensive quality improvement. 3,4 Ideally, these would be informed by a unified definition of quality. However, the complexity of the concept of quality means that obtaining a common understanding of what quality means is challenging.…”

Does staff‐assessed care quality predict early failure of dental fillings? A prospective study

“…1 Dentistry is lagging behind other parts of the healthcare sector when it comes to establishing relevant measures of care quality. [4][5][6][7] A systematic literature review on dental care quality from 2019 finds the majority of measures refer to treatment and preventive services. 7 Another systematic literature review from the same year reveals a gap in valid measurement across domains (structure, process and outcome) and dimensions (eg safety, effectiveness, timeliness, patient-centeredness, efficiency and equity) of dental care quality.…”

“…7 Another systematic literature review from the same year reveals a gap in valid measurement across domains (structure, process and outcome) and dimensions (eg safety, effectiveness, timeliness, patient-centeredness, efficiency and equity) of dental care quality. 6 Adding further to this complexity, the relevance of a measure for quality improvement purposes differs depending on stakeholder perspective and level for follow-up (eg society, dental organization, clinic, dental team, care provider, patient, tooth or surface). Finally, data on care quality can be collected from various sources such as register data, patient records, care provider assessment, patient satisfaction surveys or even workplace surveys.…”