Cancer early-detection services in community health centers for the underserved. A randomized controlled trial.

BACKGROUND: Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations. DESIGN/SETTING: A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers. INTERVENTION: Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement. EVALUATION END POINTS: The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n = 2645) and follow-up (n = 2864) record review. RESULTS: Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services. CONCLUSIONS: Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.

Linking postdoctoral general dentistry programs with community-based clinical care settings.

This article presents the results of a small workgroup convened by the American Association of Dental Schools to examine experiences related to establishing and conducting dental education programs that have significant affiliations with community-based clinical care settings. The workgroup meeting is a component of the association's effort to identify and promote innovative and non-traditional methods by which the number of postdoctoral general dentistry (PGD) positions can be increased to meet current demand for PGD education. The participants identified factors and conditions believed to be critical to successful program linkages. The information should be helpful to others as they consider opportunities to establish PGD programs or increase their number of PGD training positions.

Quality Assurance. Historical perspective and critical issues.

Quality assurance in dentistry traces its roots to the experience of medicine. Emerging challenges to the traditional practice of dentistry have created a more receptive environment for the introduction of quality assurance systems. This article underscores some of the historical perspectives as well as the critical issues facing dentistry with regard to quality assurance.

A comprehensive quality assurance system for practicing dentists.

A comprehensive outcome-oriented quality assurance methodology manual has been developed for use by practicing dentists. The audit consists of four parts. Provision for immediate feedback to providers in order to monitor behavior change is a critical part of the review process as is the emphasis on the appropriateness of care dimension, a relatively unexplored area of quality assurance activity.

Quality assurance and marketing.

Although considerable efforts have been directed toward the development and utilization of marketing strategies for dental practices, little if any information exists in the specific area of the role quality assurance may play in marketing dental services. This article describes and analyzes the current relationship between quality assurance and marketing, given the complex array of factors on the horizon that may affect how dentistry is organized and delivered. It must become the role of the profession to see that the alliance between marketing and quality assurance continues and is utilized to assure the quality of care provided and accountability to the public.

Quality assurance in a neighborhood health center: dental services.

A method for assessing the quality of dental care in neighborhood health centers has been presented. The audit uses implicit review for the evaluation of the overall process of dental care and explicit review for the technical component of the clinical audit and the evaluation of the dental record. This combined approach is favored over a totally explicit audit because it is more flexible and efficient and less threatening to the dentist. Although the "soft" structure of this audit could be criticized, the major issue is that a useable, simple quality assurance mechanism has been successfully used to improved the quality of dental care. Modifications of criteria will certainly evolve as quality assurance mechanisms improve.