Most people do not realise this, but your oral health is a window to your overall health.According to the Institute of Medicine of the national Academies, which in 2011 published the definitive report on the subject, a close oral exam can detect signs of health problems such as systemic diseases, nutritional deficiencies, microbial infections, injuries, immune disorders and even some cancers. Periodontal disease is associated with respiratory disease, pregnancy outcomes, cardiovascular disease, diabetes, and coronary heart disease. The link between the two is why a person’s oral health care will be increasingly integrated into their overall health care. As this happens, dentistry will have to embrace standardized quality and outcome measures, areas which the industry has been relatively lacking compared to the rest of the economy. The reasons wny dentistry has been lacking are varied and the subject of this article.
Dentists Don’t Capture a Lot of Information
At present, dentists generally operate according to a fee-for-service structure in which relatively little data is collected about patient outcomes. This means that the typical dentist does not have enough data to be able to make the necessary insightful inferences to improve quality outcomes. Microsoft founder, Bill Gates, has spoken about the importance of measurement to enhanced performance. Measuring stuff allows us to see if the changes we make actually work. Measurement provides the necessary feedback to enable fertile innovation. Without measurement, innovation is doomed to be erratic and rare. It’s for this reason that the fee-for-service model proves to be an impediment. Dentists simply are not measuring enough stuff and so, quality outcomes are reduced and standards of care are not as high as they could be. In order for the coming integration with overall healthcare to work, dentists will have to adopt more evidence-based methods, methods teeming in the kind of measurements that dentists don’t as-yet typically collect.
Dentists do not have broadly accepted definitions and ways of quantifying quality. The first reason for this is that diagnostic codes are not widely used. So, we do not have a sense of the rationale behind why dentists make the decision they make and arrive at the diagnosis they do. So, it is impossible to know, measure and understand if treatments are truly effective.
Secondly, dentists are trained on the technical aspects of their job. Yet, there is a difference between being good at the mechanical side of the job and making the right decisions for the long-term care of the patient. Yet, dentists do not evaluate long-term effects of their care on their patients.
Reimbursement is another issue. Incentives are a powerful force in shaping human behaviour. Quality metrics were institutionalised by the federal government as part of the establishment of Medicare and Medicaid in 1965. Dentistry did not go through a similar process and so reimbursement is not tied to quality metrics. Your dentist is usually well trained and very good at their job. But typically dental practices are small affairs, they have not undergone the scaling and consolidation that other industries have. As dental practices consolidate, they are increasingly embracing quality metrics to drive better patient outcomes.