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1. Effectiveness of care measures: Seven effectiveness of care measures were calculated. These measures report the “success” of the site in assessing risk in the patient population, in providing preventive treatment for those deemed to be at risk, and in preventing new caries and minimizing extractions. These measures represent a subset of a slightly larger set of effectiveness of care measures that have been tested and validated in several clinical environments (Bader et al., 1999a; Bader et al., 1999b) These measures are calculated separately for children (ages 6 to 17) and adults (age 18 or older). The calculation of these measures is described in Appendix K. The measures reflect performance in the year preceding the audit. 2. Use of services measures: Two measures that report use of services in the preceding year were calculated: the percentage of patients receiving at least one prophylaxis (defined by CDT-4 procedure code 1120 and 1110: Coronal scaling and/or polishing to remove coronal plaque, calculus, and stains) and the ratio of preventive procedures to intracoronal restorations. These measures represent a subset of a larger set developed and tested as described above (Bader et al., 1999a; Bader et al., 1999b). The calculation of these measures is described in Appendix K. 3. Complication rates: The proportions of extraction procedures and restorative procedures accomplished in the preceding year where post-procedure complications arose were calculated. The exact criteria for identifying the occurrence of a postprocedure complication are described in Appendix K. 4. Provision of examinations and preventive procedures: The mean annual numbers of examinations, prophylaxes, and fluoride treatments per patient, and the percentages of patients receiving oral hygiene instruction and oral cancer exams were calculated separately for children (ages 6 to 17) and adults (age 18 or older). These rates were calculated to reflect the intensity of basic examination and prevention procedures across all patients. 5. Gingival bleeding assessment: The relative proportion of patients for whom a notation was made in the chart regarding the presence or absence of gingival bleeding was calculated as an additional outcome measure with which to portray attention to periodontal health. 6. Consultation with supervising dentist: The proportion of a therapist’s patients for whom one or more consultations were sought during the course of treatment was calculated. 3.6

Record-Based Process Evaluations The record-based process review employed and chart audit assessment based on an

Office Assessment Instrument (OAI) developed by MetLife, Inc. for use as a practice improvement tool in its “preferred provider program.” In turn, the OAI was based on the work of Morris, Bentley, and Vito (1987), which used expert opinion to develop important indicators of quality for assessing dental practices; however, there are no published reports on how practices