Unit 5. Quality Assurance and Quality Improvement
Quality Assurance & Quality Improvement

Section 3. Measuring to Improve Quality

Incident-Driven Peer Review

We’ve discussed the proactive peer review that must occur in a health center to improve care, but another process is needed to when Incidents occur—for example, if a staff or a patient complains or if data from the proactive peer-review process uncover serious questions about quality of care. This type of peer review refers to a formal process where the conduct or clinical competence of a dentist is reviewed in response to a complaint or malpractice claim. State dental associations and state dental boards conduct peer-review programs to settle disputes between patients and dentists or third-party payers and dentists. The purpose of the peer-review system is to resolve disputes that may arise in the delivery of oral health services to the public, in particular, disputes about the quality and/or appropriateness of treatment, utilization (problems related to dental insurance benefits when treatment is questioned), and/or potentially irregular billing practices. It is important to understand that there are legal and regulatory reporting requirements that can be associated with this type of peer review, so obtaining legal advice is recommended when setting up this process.