Improving the quality of oral health care

June 1, 2012
Every year, my husband’s aunt and uncle give us a subscription to Consumer Reports. I have to say, we really use ...

Every year, my husband’s aunt and uncle give us a subscription to Consumer Reports. I have to say, we really use the buying guide when it comes to deciding on appliances and gadgets.

Need a new cell phone? We can count on Consumer Reports to advise us what to look for, what to skip, and what we will pay. The magazine provides a review of brands and models based on an assessment of characteristics and features. For example, qualities tested may include ease of use, voice quality, messaging, and battery life. Features reported on may include camera megapixels, memory card, broadband data, display diagonal size, and touch screen. A device will get a final recommendation of being a high performing model that stands out, or it will get a Best Buy status that indicates it offers the best combination of performance and price. All this information is laid out in an easy-to-read table so one can quickly scan and see what product got the best rating. Shopping could not be easier.

Too bad we don’t have this same quality assessment for oral health care. Consumers would know right away what to look for and how to get the most value for their money from their oral care professionals. At a time when our economy is challenged and some people view dentistry as a luxury, quality oral health care takes on a whole new meaning.

A report funded by the W.K. Kellogg Foundation and the DentaQuest Institute was recently released, and it details a way to expand oral health quality improvement. The report, entitled “Oral Health Quality Improvement in the Era of Accountability,” is available at and makes for fascinating reading.

The report provides an overview of the need to align payment incentives with health care outcomes and values for patients. It notes that our nation “spends much more of our gross domestic product on health care than the rest of the developed world and has poorer health outcomes.” This finding supports the need for health care reform.

While our health care system needs to be shaped up, we may work under the assumption that oral health care fares better. Not so.

The total national expenditures for oral health care are expected to double between 2005 and 2020. In addition, dental care is among the largest out-of-pocket health expenditures in the U.S., second only to prescription drugs.1

Numerous reports exist that detail concerns about health disparities, including oral health concerns, access to care, cost, and the need for quality measures that address performance and value for patients. Of interest to oral care professionals, “Oral Health Quality Improvement in the Era of Accountability” indicated two issues that need to be addressed — the widespread unexplained variations in clinical decisions among dentists, and the measurements that assess whether procedures are “done right” do not explain whether “the right things are being done.”1

Oral health measures need to improve and opportunities for greater accountability need to exist. Trends to watch and areas to consider include:

• Pressures to control costs and provide care to underserved populations — including racial and ethnic minorities, low-income and rural populations, and people with complex health conditions — will drive development and use of measures of oral health outcomes.

• Efforts to develop measures of oral health outcomes will drive development and use of diagnostic coding systems and other means of collecting data on oral health outcomes.

• The spread of electronic dental records (EDRs) and integrated electronic health records (EHRs) will make collection and analysis of data easier, especially across providers, and incentives for meaningful use will drive and facilitate analysis of these data.

• As the use of oral health quality measurement and improvement systems develop, more attention will be drawn to the IOM-defined quality domains (i.e., creating an oral health care system that is safe, effective, patient centered, timely, efficient, and equitable).

• Pressures to control costs and improve the oral health of vulnerable populations will drive accountability through innovations in payment mechanisms to move from “paying for volume” to “paying for value.” This will mean developing and deploying payment, monitoring, and incentives tied to the oral health of the population being served.

Addressing quality improvement systems and greater accountability in oral health care is like motherhood and apple pie. Who doesn’t want improved outcomes? Improved quality may mean improved oral health care. However, after reading this report, there are several things that concern me.

First, quality health care is not a new concept. It has been addressed for decades. Agencies have been created to study improvements. The number of agencies and organizations is a concern. All this emphasis on the quality of health care, and still the health of our nation is poor. How many agencies do we need to figure that out? At what point do we translate this information into improving health care?

Next, while all these health care quality groups have existed, it has only been recently that anyone became serious about examining oral health care. When will all these groups figure out that oral health is part of overall health and should not be a stepchild to health care? Why aren’t oral health professionals considered essential to these discussions of improvement?

Lastly, when are the powers-that-be going to acknowledge that we have health care providers who can help prevent oral disease and improve the health of the public? They’re called dental hygienists. Rather than design a new health care provider, have the powers-that-be thought of better utilizing dental hygienists? Actually, they have. Unfortunately, the political barriers are such that territoriality and control outweigh the oral health needs of our country.

Let’s cut to the chase. We need leadership and a new system for addressing the oral health of the public. We need our profession of dental hygiene to create new models for delivering oral health care, accompanied by models that address higher levels of quality and accountability. We don’t need another report that concludes that our nation’s oral health is poor, that there are barriers influencing the oral health of the public, and that we could do better. Actions speak louder than words. RDH

JoAnn R. Gurenlian, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing education programs to health-care providers. She is a professor and interim dental hygiene graduate program director at Idaho State University, adjunct faculty at Burlington County College and Montgomery County College, and president-elect of the International Federation of Dental Hygienists.

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