programs have not provided valid and reliable information on the process and outcomes of care. A 1990 survey of quality assurance programs in dental schools indicated that barely half the responding schools were reviewing the outcomes of care (Butters et al., 1991). Only three-quarters of the schools reported a responsible individual or formal administrative program for quality assurance, and nearly all such programs had been established for less than six years. Less than 90 percent periodically reviewed infection control activities, a universal expectation of quality assurance programs in most settings. Although about two-thirds of the respondents indicated that they assessed patient satisfaction with services, only 19 percent had written criteria for this assessment.

In general, then, dental educators lack both the programs and the data needed to assess the quality of care in an individual school or to compare alternative models of patient care for differences in timeliness and appropriateness. Such assessments and comparisons could prompt changes in processes of care that would serve both the mission of patient care and the mission of education.

To be fair to dental schools, quality assurance mechanisms are generally less advanced in ambulatory care settings than in hospitals (IOM, 1990e). As quality has become an increasingly important issue to policymakers, providers, health plans, and patients, this is changing. More systems and requirements for quality assessment and assurance are developing. Since the early 1980s, accreditation standards for dental schools, for example, have included certain patient protection provisions (CDA, 1993a). These involve emergency services and training, diagnosis and treatment planning, preventive services, recall procedures, and patient rights (Table 6.1).

Whether a single accreditation process is satisfactory for both education and patient care in the dental school is an important question. Reflecting its traditional reliance on the hospital as an educational site, the medical model separates the roles. The Liaison Committee on Medical Education accredits medical schools, and a variety of independent organizations, notably the Joint Commission on the Accreditation of Health Care Organizations, accredit patient care facilities and programs. Although the Joint Commission has moved beyond its original focus on hospital care, the accreditation of ambulatory care settings is in the hands of multiple, often competing organizations that are still struggling with basic criteria and procedures. As the Joint Commission begins to review ambulatory care programs including hospital-associated dental clinics, the content and source of standards for patient care programs are likely to become a more pervasive issue in the academic health center.



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