A Systematic review of quality measures used in Primary Care Dentistry

Introduction ‘Quality’ in primary care dentistry is poorly defined. There are significant international efforts focused on developing quality measures within dentistry. The aim of this research was to identify measures used to assess quality in primary care dentistry and categorise them according to which dimensions of quality they attempt to measure. Methods Quality measures were identified from the peer-reviewed and grey literature. Peer-reviewed papers describing the development and validation of measures were identified using a structured literature search. Measures from the grey literature were identified using structured searches and direct contact with dental providers and institutions. Quality measures were categorised by domains of structure, process and outcome and disaggregated dimensions of quality. Results 11 validated measure sets from 22 studies were identified from the peer-reviewed literature, comprising 9 patient satisfaction surveys and 2 practice assessment instruments. From the grey literature, 24 measure sets, comprising 357 individual measures, were identified. Of these, 96 addressed structure, 174 addressed process and 87 addressed outcome. Only 3 of these 24 measure sets demonstrated evidence of validity testing. The identified measures failed to address dimensions of quality such as efficiency and equity. Conclusions There has been a proliferation in the development of dental quality measures in recent years. However, this development has not been guided by a clear understanding of the meaning of quality. Few existing measures have undergone rigorous validity or reliability testing. A consensus is needed for a definition and the dimensions of quality in dentistry to develop core measures to assess it.