Hoelscher, Diane, Kimberly Werth, and Anthony Neely
Screening exams of new patients that include estimates of specific treatment needs can be used when assigning patients to help balance student comprehensive care experiences. However, inaccurate estimates lead to inefficiency. The objectives of this study were to 1) assess outcomes of the screening process by comparing treatment needs estimated at screening with actual treatments planned, and 2) pilot a method for gathering data to improve the screening process. After IRB approval, a randomized list of 200 records of patients having a 0150 exam between 1/03 and 1/07 was generated. Eighty-six records met inclusion criteria of screening exam immediately prior to treatment plan. Treatment needs estimated at screening and actual treatment on the signed treatment plan were compared. Descriptive statistics for patient demographic data were completed. The data suggest clinically apparent treatment needs had a higher level of agreement. The collection and analysis of additional data to identify variables that modify treatment choices are needed.
The sample was 44.2 percent male and 55.8 percent female. A total of 65.1 percent had private dental insurance, 23.3 percent Medicaid, and 10.5 percent self-pay. Twenty-four potential procedures were analyzed. Treatments where >50 percent of subjects had data were defined as sufficient for data analysis. Amalgam restoration, composite restoration, scaling/root planing, prophylaxis, crown, and post/core met the criterion for analysis. Percent agreement between initial clinical screening and final treatment plan were 70.8 percent, 52.5 percent, 52.5 percent, 44.3 percent, 36 percent, and 25.7 percent, respectively.
More data are needed to make inferences regarding screening agreement or relationship between demographic or other variables and estimations of treatment needs at screening. Many variables, such as screener calibration, limited diagnostic ability during screening, patient desires, capacities of student dentists to provide care, and others may impact the ability to predict patient treatment needs. Further study, including task analysis of steps between screening and treatment plan, faculty calibration, and longitudinal assessment of patients from screening through treatment completion, is needed.
The comparison of agreement between screening and treatment plan is a logical first step in evaluating outcomes of a patient screening system and could be used by schools to make informed decisions regarding improvements.