Use of quality measurement across US dental delivery systems: a qualitative analysis.

OBJECTIVES: Dentistry is increasingly challenged by payers and the public to demonstrate quality measurement (QM) activities that substantiate value. Unknown is how various components of the US oral health-care financing and delivery systems have adopted QM. The objective of this study is to explore QM activities by US dental delivery, management, financing, and related organizations. METHODS: Using a structured interview guide based on a novel conceptual framework that incorporates factors influencing QM intention, adoption, and implementation, 19 key informant interviews were conducted. Informants represented safety net delivery programs (health center, nonprofit mobile, hospital-based, Veterans Administration, and tribal dental programs), private delivery organizations (private practice, closed panel HMO, and for-profit mobile dental programs), training programs that deliver care (dental and dental therapy programs), management organizations (private and Medicaid group practice management companies), care financing organizations (Medicaid managed care plan, state Medicaid program, dental benefits companies), and dental quality organizations (institute and dental professional organization). Interviews were transcribed and analyzed qualitatively. RESULTS: Informants report wide variation in the intensity of QM efforts with organizational leadership cited as most influential. Motivation to adopt QM efforts is more often internal than imposed. Data management and information technology both facilitate and limit QM activities. QM activities are associated with operational improvements including use of guidelines and refinements of mission. Organizational type and size appear to influence QM programs. CONCLUSION: The current status of QM is highly variable across dental organizations because organizational leadership, needs, and requirements vary according to mission and structure.

Evaluating a Cultural Competency Curriculum: Changes in Dental Students' Perceived Awareness, Knowledge, and Skills.

In response to current and projected demographic changes in the United States, many dental schools have taken steps to increase the cultural competence of their students through various educational methods. The aim of this study was to evaluate the effectiveness of the cultural competency curriculum at Boston University Henry M. Goldman School of Dental Medicine (GSDM). The curriculum was evaluated using a pre and post design, utilizing an instrument developed for pharmacy students and modified for dental students. The questionnaire was comprised of 11 items designed to assess changes in students' awareness, knowledge, and skills in providing culturally competent care. Data were collected for two classes of second-year DMD students and first-year Advanced Standing students. The total number of returned surveys was 485, for a response rate of 79.5%. The students' post-curriculum mean scores were all higher than their pre-curriculum scores for overall cultural competence (pre 26.5±6.3 to post 29.8±7.2) and for individual subscores on awareness (pre 5.3±1.4 to post 5.5±1.5), knowledge (pre 7.2±1.9 to post 8.1±2.1), and skills (pre 14.1±4.4 to post 16.2±4.4). The improvements on all scores were statistically significant (p<0.0001), with the exception of the awareness component. This evaluation suggests that the cultural competency curriculum at GSDM has been effective in producing improvements in these students' cultural competence in the domains of knowledge and skills.