Dental Education at the Crossroads Challenges and Change (1995) / Chapter Skim
Currently Skimming:
6 THe Mission of Patient Care
6 THe Mission of Patient Care
Pages 174-198
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 174... ...
This chapter, thus, draws heavily on the committee's site visits and other activities, its broad understanding of the forces reshaping health care delivery and financing, and its judgments about the fit between patient care in the dental school and a restructured health care system. CONTEXT An examination of patient care activities in the dental school and academic health center must consider the patient as an indi 174
|
From page 175... ...
To the administration of a university or academic health center, the outpatient clinics of a dental school may be a mystery different from any component of the medical school and in chronic need of subsidy. These varied perspectives challenge dental schools to clearly articulate the value and requirements of their patient care mission.
|
From page 176... ...
WHO PROVIDES PATIENT CARE IN DENTAL SCHOOLS ? In most dental schools, the majority of patient care activities are provided by students.
|
From page 177... ...
Within the dental school, care provided by students may be organized around specialty clinics or comprehensive care clinics. Chapter 4 describes these alternatives primarily from an educational perspective but notes that a patient-oriented objective of comprehensive care is to put the patient-general practitioner relationship at the center of the clinic and to provide care in a setting as similar as possible to an efficient private practice or community clinic.
|
From page 178... ...
STATISTICAL PROPILE or PATIENT CARE IN DENTAL SCHOOLS Detailed information on dental services is in relatively short supply, and dental schools are no exception. Because they are part of large organizations that routinely collect and report information, however, dental school utilization statistics may be more complete than data for private practices.
|
From page 179... ...
With fewer students to provide patient care, patient visits in dental schools declined by 29 percent and the number of patients screened decreased by 13 percent {Figure 6.1~. Numerically, patient visits fell from 4.63 million in 1984 to 3.31 million in 1992, and total patients screened dropped from a high of 396,000 in 1985 to 343,000 in 1992.
|
From page 180... ...
In addition, because oral health has improved even in the relatively disadvantaged populations served by most dental schools, dental schools today have to screen more patients to secure an adequate yield of clinical problems {numbers and typesJ for educational purposes. From 1985 to 1992, clinic income increased from $ 104.9 million to $171.9 million {AADS, 1993b)
|
From page 181... ...
A procedure-driven learning process does not necessarily translate into efficient, highquality patient care, particularly when student care is further constrained by low budgets for clinical and administrative support. Thus, patients who can afford care elsewhere typically seek service in other settings, and health plans that contract with a limited set of providers do not look to dental school clinics first.
|
From page 182... ...
Whether viewed from an individual patient or a health plan perspective, the patient care challenges for dental schools are significant. They include issues related to efficiency, quality, competitiveness, accountability, and informed consent.
|
From page 183... ...
Although the focus of this strategy is broadly on patient care, not narrowly on procedures, and the learning process is structured differently, procedural competency is still an objective. For the patient, this strategy is likely to mean less time in the clinic.
|
From page 184... ...
. Quality problems occur in all settings, but the dental school has some particular vuinerabilities.
|
From page 185... ...
Both of these quality of care problems reflect social policies over which dental schools have little control, although dental schools may lobby for improved Medicaid coverage of dental services, for direct public and private support for their own clinic and outreach programs, and for other community-based programs to which they can refer some patients. The above discussion emphasizes problems, but the dental school clinic also may have characteristics that are linked to higherquality care including frequent faculty interaction with peers in the same or other disciplines and a systematic process and explicit criteria for evaluating individual treatments.
|
From page 186... ...
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, 1990eJ.
|
From page 187... ...
An individualized prevention program should be an integral component of all comprehensive patient care activities. 6.1.5 Each institution must provide for all registered patients a dental emergency service accessible at all times.
|
From page 188... ...
Practitioners, administrators, and consumer advocates are struggling to devise strategies that permit truly informed consent to care from culturally and clinically diverse patients who receive remarkably varied services in different settings and circumstances. Within the dental school, informed consent collected at the screening stage is insufficient because a plan of treatment has yet to be devised to which a patient can consent.
|
From page 189... ...
Today, some dental schools have a backlog of patients, and patients may wait weeks for an appointment {Tunnicliff, 1994~. At the same time, these schools and others may worry about a shortage of certain types of patients for their student clinics.
|
From page 190... ...
Faculty practice plans that incorporate care by predoctoral students may, however, not be attractive to health plans that include only a limited set of health care providers. COMMUNITY SERVICE During the 1970s, many dental schools developed community dentistry departments or programs that provided clinical experiences in community health settings for most dental students.
|
From page 191... ...
The rethinking process will highlight the relationship of the dental school to the academic health center and the relationship of both to a changing health care delivery and financing system. Because the health care system is a complex mixture of national, state, and community influences and institutions and because each dental school's situation has its own special characteristics, each school's own reassessment and restructuring process will be different.
|
From page 192... ...
In preceding sections of this chapter, some specific options for dental schools to improve their patient care mission are proposed or implied. They include · strategic planning that anticipates continued restructuring of the health care system; · adoption of a formal, comprehensive quality assurance and improvement program; · increased faculty accountability for patient care and more reliance on residents (for schools that have relevant graduate programsJ; · more efficient administration of nonclinical activities; · improvement of information systems to support outcomes research, quality improvement, and effective management; · possible separation of accreditation programs for education and patient care; and · integration with the patient care activities of the entire academic health center.
|
From page 193... ...
It also overlaps with topics such as practice guidelines and outcomes research that have been discussed in other chapters. Patient care within dental schools needs, however, an overarching mode!
|
From page 194... ...
Faculty Accountability Some dental schools are already moving to increase faculty accountability for patient care. The most definitive step is to assign responsibility for each patient to a faculty member who works with students, other generalist and specialty faculty, allied dental personnel, and administrative staff to match patient problems to student needs and capacities and who ensures comprehensive patient care by providing, overseeing, and coordinating services.
|
From page 195... ...
Accreditation The dental community, most notably the Commission on Dental Accreditation and the American Association of Dental Schools, must address the collective processes for overseeing the quality of dental education and the quality of patient care within the dental school. If dental school clinics follow the path of competition and integration outlined elsewhere in this chapter, the develop
|
From page 196... ...
Dental schools that are not part of an academic health center could, in principle, seek integration or involvement with other institutions. Whether they would be attractive partners absent some preexisting connection probably would depend on how attractive patient care within the dental school could be made.
|
From page 197... ...
To affirm that patient care is a distinct mission, each dental school should support a strategic planning process to · develop objectives for patient-centered care in areas such as appointment scheduling, completeness and timeliness of treatment, and definition of faculty and student responsibilities; · identify current deficiencies in patient care processes and outcomes, along with physical, financial, legal, and other barriers to their correction; and · design specific actions including demonstration projects or experiments to improve the quality, efficiency, and attractiveness of its patient services. To respond to changes in roles and expectations for providers of outpatient health services including dental school clinics, the Commission on Dental Accreditation and the American Association of Dental Schools should · reexamine processes for assessing patient care activities in dental schools and ensuring the quality of care, and · begin to evaluate new options such as eventual participation by dental schools in separate accreditation programs for their ambulatory care facilities.
|
From page 198... ...
Such a perspective has not been typical among dental schools, and most schools' views of their patient care mission are still evolving as are their strategies for fulfilling this mission. Changes in the role of health professions schools and academic health centers both in the university and in the larger health care system will put pressure on dental schools to improve the efficiency and quality of their patient services.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.