Patient-Centered Dental Home (PCDH) Quality Indicators Clearinghouse

The Patient-Centered Dental Home (PCDH) project is building a framework that identifies the essential characteristics of a PCDH and connects those characteristics to specific measures. The project is being conducted in 4 phases:

• Phase 1 (complete): PCDH Definition, including essential characteristics(e.g., accessible)
• Phase 2 (complete): Components of each essential PCDH characteristic (e.g., timely)
• Phase 3 (complete): Measure concepts included in each component (e.g., percentage of population that obtains necessary dental care)
• Phase 4 (complete): Specific Quality Indicators, including Measures and Standards

To identify existing dental quality and performance measures and accreditation standards, we first compiled measures from environmental scans previously conducted by the Dental Quality Alliance (DQA) (including practice-based and pediatric measures) and the National Quality Forum (NQF), as well as standards from the major organizations that  accredit or recognize practices as dental homes or patient-centered medical homes, including AAAHC and NCQA^[1], respectively. Next, we focused our search on identifying dental measures that were either new or updated since the DQA and NQF environmental scans were conducted in 2012. This included a PubMed search and an online search.

The online search included a search of health systems, organizations, ACOs, practices, third party payers, state Medicaid programs, and other groups that were either known to be involved in dental quality measurement or were identified through an online search. Measures not already identified from the DQA and NQF environmental scans were added to the clearinghouse.

Quality indicators were classified by PCDH characteristic and component.  Quality indicators could be classified in more than one characteristic/component. Quality indicators were categorized as either a measure or a standard, which were defined as follows:

• Measures are “tools that help measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care.”^[2]They facilitate quality improvement by allowing for consistent reporting over time and include both a numerator and denominator. An example measure is the proportion of children age 6-9 years old who receive sealants on a permanent first molar. 
• Standards are evidence of policies and procedures undertaken by practices to meet externally-identified or internally-identified quality standards and quality improvement goals. These are collected through self-report by a provider or practice and may be in the form of clinic protocols, reports, etc. An example documented process is implementation of a secure electronic system for two-way communication to provide timely clinical advice. 

Items were also categorized by data source (e.g., survey report, administrative claims data) and level of measurement (e.g., population, plan, practice). A full list of the included measures and standards can be found by navigating the clearinghouse linked above. Complete information was not available for all measures; therefore, some fields may be missing.

The measures and standards contained within the clearinghouse have varying degrees of development and testing, and information on the extent of measure testing and current use status was often limited. The current status of measures should be verified with measure steward prior to using. Inclusion in the clearinghouse should not be interpreted as a recommendation for use or an assurance of measure reliability and validity. Where available, measure endorsement and testing by other entities (e.g., Dental Quality Alliance and National Quality Forum) have been noted.

Because there are an extensive number of oral health related surveys and, often, many variations of those surveys, this scan did not undertake a comprehensive scan related to patient-reported measurement.  Some survey items that are commonly used for performance assessment and quality improvement (e.g., Consumer Assessment of Healthcare Providers and Systems) were included.  For a comprehensive scan of oral health patient-reported measurement, refer to the Dental Quality Alliance’s Environmental Scan of Patient Reported Oral Healthcare Measurement (2020).