clinical technical performance and performance measures;
record-based process measures and evaluation of clinical facilities; and
implementation of community-based preventive plans and programs.
Caveats: Issues Not Addressed by this Evaluation
This is not a randomized trial of quality assessment that compares the outcomes of licensed dentists with those of therapists, although we were able to collect, in a blinded, unbiased fashion, data that permit comparisons of the technical excellence of prior restorations provided by members of the two groups. Such information is valuable and informative. Similarly, this is a cross-sectional assessment that does not afford a reliable quantitative assessment of how dental care access may be changing in bush Alaska. The program is too new and comprises too few therapists to expect such quantification at this time. By nature, a crosssectional assessment is one that provides insight into how the DHAT program is operating at a single time point of observation. Such an assessment provides valuable information, but this design does not permit an evaluation of what the impact of the DHAT program may be on the oral health of the community over time. For this reason, we included in the evaluation an oral health survey of residents in each village that can serve as a baseline for future longitudinal studies. The oral health survey provides the context in which the therapists and other dental providers are operating. However, to reiterate, the oral health survey’s cross-sectional nature does not enable attribution to a program or a particular provider as having either a positive or negative impact. The survey should be viewed as a snapshot in time, but a picture with considerable clarity nonetheless. Moreover, this evaluation was consciously undertaken with a narrow scope in mind: to evaluate—using transparent quantitative and qualitative methods—the implementation of the DHAT program in five practice sites in Alaska. We undertook this effort knowing full well that there are few, if any, widespread and evidence-based standards for assessing dental practice performance. There are no uniformly accepted practice groups whose standardized performance can serve as a valid comparison for what we undertook to observe. These caveats should be kept in mind when considering the microscopic scrutiny to which we applied our examination of the implementation of the DHAT program. Applying similarly intense scrutiny to the routine practice and performance of licensed dentists currently in private practice in Alaska, as well as those in the lower 48 states, would be most illuminating. Such examination is beyond the scope of the current project and must await future study and availability of interest and resources.