Using Medicaid claims to construct dental service market areas.
OBJECTIVE: To use Medicaid claims data to construct patient origin-based market areas for dental services and compare constructed market areas with those based on the practice county. DATA SOURCES: North Carolina Medicaid claims, eligibility, and provider files, the Cooperative Health Information Systems' dentist licensure files, and the Log Into North Carolina data. STUDY DESIGN: A visit-level file was created from the Medicaid claims data and aggregated by provider practice county and patient county of residence. Using the aggregated file and an algorithm based on the Elzinga-Hogarty approach, patient travel patterns were used to construct mutually exclusive patient origin market areas. DATA ANALYSIS: Market area characteristics were compared across definitions using Pearson correlation coefficients. In addition, estimations of provider participation were performed using market area characteristics as control variables. The beta coefficients associated with market area characteristics were compared across market area definitions. PRINCIPAL FINDINGS: Medicaid claims data, when combined with provider licensure files, can be used to construct market areas based on patient origin data. However, measures of market area characteristics are correlated highly between the two types of market areas studied. Furthermore, beta coefficients on market area variables in models of provider participation are similar in sign, significance, and magnitude across market definitions. CONCLUSIONS: Compared with market areas constructed using patient origin data, county-based market areas adequately proxy for dental markets. Using the county as the market area also avoids the time and computational costs associated with using a patient origin-based approach and facilitates the use of widely available data. (+info)
Ethics--dental registration in the seventeenth and early eighteenth century.
In the histories of dentistry, some mention is made of the licensing of tooth-drawers, and those who provided dental healthcare before the term Dentist started to become general in the late eighteenth and early nineteenth centuries. One of the most striking references to licensing appears in a little piece of doggerel printed under a 1768 print by Dixon after Harris. (+info)
Is it time to change state and regional dental licensure board exams in response to evidence from caries research?
State and regional board exams represent the final gateway to dental licensure. One would expect that the requirements for licensure would reflect procedures that are beneficial to each patient's oral health and that are consistent with the teachings of most dental schools. We conducted an Internet survey to determine whether Class 2 tooth preparations based on caries lesions whose radiolucencies were confined to enamel were allowed for state and regional exams. Information obtained for 46 of the 50 states revealed that 33 of the states (72%) allowed teeth with either an E1 or E2 lesion to be restored. Seventeen of these states allowed teeth with an E1 lesion to be restored. Only 12 of the 46 states (26%) covered by these boards did not allow teeth with E1 or E2 lesions to be surgically treated. In contrast, a recent report indicates that only 30% of dental schools permit teeth with enamel lesions to be restored to satisfy clinical requirements and competencies. (+info)
The relationship of performance on the dental admission test and performance on Part I of the National Board Dental Examinations.
Although many schools use scores on the Dental Admission Test (DAT) to evaluate applicants, the association of these scores with students' performance on Part I of the National Board Dental Examinations (NBDE) has not been recently evaluated. In this study, the hypothesis that the DAT scores would be a significant predictor of Part I of the NBDE scores was tested. We analyzed by multiple regression the scores on both examinations for the 114 students matriculating in the University of Mississippi School of Dentistry in 1992, 1993, 1994, and 1995. The results indicate that DAT reading comprehension was a statistically significant predictor (p value less than or equal to 0.05) of all four subtests of Part I of the NBDE. The DAT biology and organic chemistry scores were statistically significant predictors of NBDE biochemistry-physiology, and the DAT quantitative analysis score was a statistically significant predictor of NBDE dental anatomy and occlusion. DAT perceptual ability and general chemistry were not significant predictors. (+info)
Banning live patients as test subjects on licensing examinations.
The use of live patients on the licensing examinations was a part of dentistry for almost the entire twentieth century and continues up until today. Considerable new debate about the appropriateness of using live patients as test subjects began in the mid-1990s and culminated in the passage of a resolution in the American Dental Association's year 2000 House of Delegates calling for an end to this practice by the year 2005. The live patient examination tests a narrow range of clinical skills, creates ethical dilemmas for candidates, for the host institution, and for the profession, and is unable to distinguish between those ready to assume independent practice from those who are not yet at that level of competence. There are other ways to test for such readiness including proposals in New York State to substitute a postdoctoral year or mannequins in place of live subjects. The public and the dental profession will be better off by developing alternative licensing tests to the use of live subjects. (+info)
Assessing the effectiveness of a new curriculum: Part I.
Although it is important to assess the effectiveness of programs, courses, and teaching methods to ensure that goals are being achieved, it is very difficult to evaluate the impact of fundamental changes in a whole curriculum. This paper reviews measures that have been used in the past in dentistry and medicine for evaluating academic programs: curriculum guidelines; competency documents; discussion and focus groups; competency examinations; board examinations; oral comprehensive examinations; student, alumni, and patient satisfaction surveys; evaluation by instructors; and clinical productivity. We conclude that, since no standard method exists, several tools should be used to obtain a multidimensional assessment. (+info)
Dental education in Europe: the challenges of variety.
Dental education varies considerably across Europe, with differing traditions of stomatology (dentistry as a specialty of medicine) and odontology (single autonomous discipline). Dental curricula within the European Union (EU) are governed by European law expressed in directives that are binding on all EU member states. The Dental Directives (78/686/EC) base the curriculum on the odontological model, but compliance by individual schools is often poor. The differences within the EU will likely intensify with the accession of Eastern/Central European countries where the stomatological tradition is strong. Moreover, current proposals within the EU will reduce even the limited existing effectiveness of the Dental Directives. The DentEd Thematic Network Project, which aims to promote convergence of European curricula through voluntary self-assessment and outside peer review, has involved about 25 percent of European schools. Its effectiveness in inducing changes in individual schools is unknown. It is not an accreditation system, and there is no intention to establish a European-wide common curriculum. Dentists' vocational training, here defined as "the organised education of the newly qualified dentist in supervised practice," is present in various models in many European countries, but is compulsory in only a few. Continuing dental education (CDE) is encouraged in most countries, but CDE-dependent licensure is required in only two. (+info)
Dental licensure reaches a crossroads: the rationale and method for reform.
Following calls to reform the dental licensure process, New York state has adopted an innovative approach that is responsive to the perceived shortcomings of the existing Part III examination. This solution eliminates the legally, psychometrically, and ethically compromised system, replacing it with a requirement that both ensures the public's protection and gives the new dentist additional experience in contemporary procedures in a supervised setting. The best preparation for the practice of dentistry is the practice of dentistry--something so profound and simple; yet it constitutes the core of New York's revolutionary reform. And the best way to measure that preparation for initial licensure is with the continual evaluation that occurs during the postdoctoral experience. New York is the first state to allow applicants for licensure to substitute the successful completion of a postdoctoral clinical program--a test in itself--for the traditional clinical licensure examination. The primary objective of this reform is to improve the quality of dentistry by elevating the standards for licensure. New York's expanded training protocol parallels that of medicine and reflects developments in the science and practice of the dental profession. The introduction of this new professional training model renders the clinical examination requirement obsolete. The fundamental principle of New York's new system is that a clinical examination is unnecessary to verify that a dentist is competent to enter practice following postdoctoral clinical training consisting of ongoing patient care, continuous oversight, mentoring, and evaluation. (+info)