In general, there are three methods to ascertain clinical quality in dentistry:
When these are used to analyze the results in a process that improves care, it is considered proactive peer review. All three of these methods have advantages and drawbacks.
Advantages
Disadvantages
Advantages
Disadvantages
Advantages
Disadvantages
There is evidence that a relationship exists between the quality of clinical record keeping and the quality of care provided. Quarterly chart reviews can provide information to determine trends in quality of clinical care. If a clinic employs more than one dentist, chart review data can be used in aggregate to measure the overall quality of the clinic. Dentists are often more accepting of clinic-wide reviews than of dentist-focused reviews.
If ongoing monitoring reveals problems or trends, then aggregate data can be broken down by dentist to see if the trend is dentist-focused or clinic-wide. Problems present in the records of multiple dentists most likely represent problems with systems or procedures and should be analyzed from that standpoint. Problems or trends that point to a single dentist can be related to systems problems or to problems with the dentist’s skills.
Since direct observation is the most difficult to do, you might want to reserve it for times when clinical issues arise and a more focused review is required for a specific dentist. You can also use less direct methods like clinical photographs to obtain information that you may not get in a typical chart audit. As an example, you could have a new dentist or one that has had clinical issues take pictures of the first 10 endodontic access preps or crown preps that he or she does so they can be reviewed during administrative time.
Whichever method you use, it is ideal to have a document that describes how each question on the chart audit or each procedure being observed will be evaluated so your dentists know what is expected of them. Quality is best achieved when your dentists understand the quality that you expect. Review must be discussed with dentists and staff as part of your QI process. It is important to know that charts audits are limited in what practice details they can pick up. They are good for analyzing if the correct number of radiographs are being taken or if blood pressure checks are done at every exam, for example, but owing to the small number of charts audited they may not pick up on issues arising from incorrect clinical techniques or poor patient-management skills. It is critical to report back all results of every review to the dentists and discuss any improvements that are needed.