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Issues Addressed by this Evaluation For those who provided resources for this program evaluation, those who served on

project advisory committees, and those individuals and their institutions who participated in or contributed to this project—supporters and advocates as well as potential critics and detractors— the overriding areas of focus of this evaluation have been on (1) the care provided by the therapists, and (2) changes in access to care for eligible program beneficiaries. Although measures of quality of care are compelling in their capacity to inform ways to improve the provision of dental care in the future, there are few measures available to assess the quality of care in dental practices, and virtually no published or widely accepted performance standards for these measures (Bader, 2009). Thus quality assessment, by necessity, must be descriptive but not comparative. Although there are reasonable measures of access, having access does not necessarily guarantee patient health unless the definition of access includes the concept that health care services will maintain or improve health or otherwise provide “quality care.” Therefore, what we provide in this report is an in-depth case study of Alaska tribal health organizations as they implemented a program based on a provider model that was developed nearly 90 years ago in New Zealand and has been emulated in over 40 countries worldwide (Nash et al., 2008). We have employed both quantitative and qualitative methods to collect a rich array of data on the program implementation process that each of the tribal organizations employing New Zealand-trained therapists has undertaken and experienced. 1.2

Goals of this Evaluation

Our general approach was to provide, beginning in 2008, a broad and comprehensive assessment of the implementation of the DHAT program by assessing practice activities in sites within each of the five tribal health organizations that currently employ New Zealand–trained therapists. The overall purpose of this project was to evaluate the implementation of the DHAT program, with a particular emphasis on assessing the care and current practice characteristics that may be influencing changes in levels of access to care. Regarding practice characteristics, there are no published results on how existing practices comply with many of the selected areas studied; however, since the outcome of this study was to assist ANTHC in improving the program as they move forward, we decided to collect such information in addition to assessing care. In addition, we included a cross-section series of oral health surveys in each site to provide a baseline assessment for future longitudinal studies. Specific areas of focus included ƒ

patient satisfaction, oral health–related quality of life, and perceived access to care;


oral health status;