Improving the Quality of Dental Care by Implementing a Clinicial Checklist

项目摘要 近年来，护理质量和患者安全已成为卫生保健的焦点。因此，许多组织 和机构已经制定了计划和倡议，以提高医疗护理质量和患者安全。 然而，牙科还没有赶上这种“质量”趋势。虽然很少有地方性的尝试来改善 牙科病人护理的质量，我们不知道任何系统或标准化的方法，这一主题在牙科。为 医疗保健研究和质量机构（AHRQ）指出，“衡量牙科护理质量的能力是 改善它”。在病人的一生中，对个人健康信息进行细致的收集和记录， 是提供适当护理的最重要投入之一。然而，我们的初步工作表明， 直接影响（或作为衡量）牙科护理质量的基本诊所条目是 经常从许多病人的记录中消失。这意味着，虽然大多数牙科保健提供者同意什么应该 他们经常习惯于达不到自己的标准。因此，需要一个 战略，弥补了不可避免的人类不足，并帮助牙科专业人员始终符合公认的 临床指南，以便提供尽可能高质量的护理。 为此，基于其在医学中的巨大成功，我们的工作提出了使用临床检查表。它 将有助于加强现有的临床信息确定和记录结构， 促进护理质量审核/改进。我们还将开发一个患者图表审计工具，用于基准 护理质量，并以一致的方式评估我们的“检查表”干预措施随时间的影响。 我们的具体目标是：（1）确定临床医生未能一致记录相关临床患者的原因 信息和;通过确定牙科临床最佳实践的遵守情况来确定护理质量的基准。(2)开发一个 用于一般护理牙科的临床医生检查表和患者图表审核工具。(3)实施临床医生检查表并评估 它对遵守标准记录做法和病人护理质量的影响。 通过一项严格的调查，我们将确定为什么临床医生不经常遵循共识临床最佳 实践，然后我们将创建一个临床医生检查表，并测试其有效性和可用性， 适当地还将开发一个审计工具，用于确定两个医院的护理质量基线水平。 实践（教学和教师）的哈佛牙科中心。然后，我们将以电子方式在 教学实践（学术实验室）和教师实践（私人实践实验室），然后评估其影响 对临床最佳实践的遵守程度和使用审计工具的患者护理质量。超越其直接 影响，我们期望这项工作将为程序和专业的开发和实施提供一个模型- 具体的检查表，以防止错误和提高牙科护理质量。

PROJECT SUMMARY Quality of care and patient safety have become focal points of health care in recent years. As a result, many organizations and institutions have developed programs and initiatives to improve quality of care and patient safety in Medicine. Dentistry, though, is yet to catch up on this 'quality' trend. While few localized attempts are being made to improve quality of dental patient care, we are unaware of any systematic or standardized approach to this topic in Dentistry. As the Agency for Healthcare Research and Quality (AHRQ) puts it, "the ability to measure the quality of dental care is a key to improving it". The meticulous collection and documentation of personal health information throughout a patient's life can be one of the most important inputs to the provision of proper care. Our preliminary work shows, however, that fundamental clinic entries that either impact directly on (or serve as a surrogate for measuring) quality of dental care are often missing from many patient records. This implies that although most dental care providers agree on what should make up 'best practices'; they are frequently wont, to fall short of their own standards. Consequently, there is need for a strategy that makes up for inevitable human inadequacies and helps dental professionals consistently meet well-accepted clinical guidelines so that the highest possible quality of care is provided. To this end, based on the immense success of its use in Medicine, our work proposes the use of a clinician checklist. It will help strengthen the existing structure of clinical information ascertainment and documentation, and ultimately facilitate quality of care audit/improvement. We will also develop a patient chart audit tool that will be used to benchmark quality of care, and evaluate the impact of our 'checklist' intervention over time, in a consistent manner. Our specific aims are to: (1) Identify reasons why clinicians fail to consistently document pertinent clinical patient information and; benchmark quality of care by determining adherence to clinical best practices in dentistry. (2) Develop a clinician checklist and patient chart audit tool for general care dentistry. (3) Implement the clinician checklist and assess its effect on adherence to standard record taking practices and quality of patient care. Through a rigorously developed survey, we will identify why clinicians don't routinely follow consensus clinical best practices, following which we will create a clinician checklist and test it for validity and usability, making modifications as appropriate. An audit tool will also be developed and used to determine the baseline level of quality of care at both practices (teaching and faculty) of the Harvard Dental Center. We will then electronically implement the checklist within the teaching practice (academic laboratory) and faculty practice (private practice laboratory) and then evaluate its impact on the level of adherence to clinical best practices and quality of patient care using the audit tool. Beyond its direct impact, we expect that this work will present a model for the development and implementation of procedure and specialty- specific checklists for the purposes of preventing errors and improving quality of care in Dentistry.