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of licensed dentists comply with these measures. There are also no studies evaluating the association of these measures with independent quality of care or patient outcome assessments. The process review evaluated treatment-related processes based on information available in patient records. All of the sampled records were of patients who had been treated by the therapist, but other providers may also have provided dental care and contributed to the patient’s record during the time interval under study. This review included evaluation of the organization and completeness of the record, the presence and appropriateness of the treatment plan, and the most current bite wing radiographs. Examiners received didactic training on the use of the process review instrument. Didactic training was supplemented by a hands-on review of 8 patient records at each public health clinic. From a total of 200 record audit ratings (25 items in 8 patient records), one examiner completely agreed with the trainer evaluator, and the other examiner disagreed on two ratings (1%). Eight patient records at each site were evaluated. At Site A, both examiners participated in the process review. At Sites B–E, one of the examiners completed these evaluations. Missing data for some items in the process review resulted from the inadvertent inclusion of children’s dental records in the review sample at four sites. At one site, no patient ages were recorded. Because the process review was designed for use with patients 18 years or age and older, four items were excluded from the analysis. 3.7

Clinic Facilities, Policies, Personnel, and Procedures Evaluations Aspects of the clinics were evaluated using a set of attributes and criteria based in part on

the work of Morris et al. (1987). The purpose of collecting this information was to assist ANTHC in quality improvement activities and to gain a baseline of information. As noted earlier, this is a system-level assessment of the environment in which the therapists and other providers are operating. Such observations are informative but not fully attributable to a single individual provider because multiple individuals provide dental care to residents at each evaluation site. The clinic evaluation consisted of 91 items assessing quality criteria, which were organized into 8 dimensions: facilities (8 items), equipment (10 items), personnel numbers and training (6 items), written descriptions of administrative systems for patient care (9 items), personnel and Occupational Safety and Health Administration (OSHA)-related elements of infection control (10 items), materials for patients (4 items), practice management (5 items), and sterilization and infection control (39 items). Each item received a satisfactory or unsatisfactory rating. The evaluation instrument used to collect data in the clinics is shown in Appendix L. 3-7