Unintended consequences and challenges of quality measurements in dentistry

Abstract

Background In recent years, several state dental programs, researchers and the Dental Quality Alliance (DQA) have sought to develop baseline quality measures for dentistry as a way to improve health outcomes, reduce costs and enhance patient experiences. Some of these measures have been tested and validated for various population groups. However, there are some unintended consequences and challenges with quality measurement in dentistry as observed from our previous work on refining and transforming dental quality measures into e-measures. Main body Some examples of the unintended consequences and challenges associated with implementing dental quality measures include: a de-emphasis on patient-centeredness with process-based quality measures, an incentivization of unethical behavior due to fee-for-service reimbursement systems, the risk of compromising patient and provider autonomy with plan-level measures, a disproportionate benefits of dental quality measurement going toward payers, and the risk of alienating smaller dental offices due to the resource-intensive nature of quality measurement. Conclusion As our medical counterparts have embraced quality measurement for improved health outcomes, so too must the dental profession. Our ultimate goal is to ensure the delivery of high quality, patient-centered dental care and effective quality measurement is the first step. By continuously monitoring the performance of dental quality measures and their continued refinement when unintended consequences are observed, we can improve patient and population health outcomes.

Measuring the quality of dental care among privately insured children in the United States

“…14 Because the majority of current DQMs are based on process and access measures, mainly due to lack of standardization and implementation of diagnostic codes in dentistry, they may not adequately represent the true quality of dental care. 17 As quality measures evolve in dentistry, attention needs to be focused on developing measures that are diagnosis-and patientcentered, such as electronic measures (e-measures) that can be deployed through the electronic health records (EHRs) at dental practices or digital quality measures that would be more accurate and person specific. 37,38 Although our study population represents approximately 3.5% of children covered by commercial dental insurance plans in the United States, our results may not be generalizable beyond the study population, especially to children who are publicly insured or uninsured.…”

“…Clinical quality measures are suggested to encompass five domains (process, access, outcome, structure, and patient experience) in the United States, 36 and seven domains (patient safety, effectiveness, efficiency, patient‐centeredness, equitability, timeliness, and access to care) based on working definition of quality of dental care globally 14 . Because the majority of current DQMs are based on process and access measures, mainly due to lack of standardization and implementation of diagnostic codes in dentistry, they may not adequately represent the true quality of dental care 17 . As quality measures evolve in dentistry, attention needs to be focused on developing measures that are diagnosis‐ and patient‐centered, such as electronic measures (e‐measures) that can be deployed through the electronic health records (EHRs) at dental practices or digital quality measures that would be more accurate and person specific 37,38 …”

“…Given large variations in dental utilization among children and the relatively recent development of quality measures in dentistry, quantifying the quality of dental care using DQMs 17 is an important first step. Information derived from DQMs could provide a nationwide assessment of variation and longitudinal trends in dental quality of care and identify subpopulations in need of quality improvement.…”

Measuring sealant placement in children at the dental practice level

“…We are also aware that there is a separate debate on how quality measures should be used, and if they should be tied to reimbursements or incentives. 38 There may be other unintended consequences after these measures are implemented in practice that need further study.…”

Criteria and Indicators of Dental Care Quality: State of Development and Usage

“…Значення критеріїв і індикаторів якості для оцінки ефективності системних змін і поліпшення результатів для пацієнтів є предметом уваги багатьох наукових досліджень, зокрема, при оцінці якості стоматологічної допомоги як невід'ємної складової системи охорони здоров'я [6]. Разом з тим, дослідження підходів до формування закладами охорони здоров'я критеріїв та індикаторів якості в умовах реальної вітчизняної стоматологічної практики поодинокі [7] Результати дослідження.…”