FYI

In California, the Department of Managed Health Care (DMHC) requires that all dentists receive yearly on-site quality assessment (QA) reviews. These reviews evaluate how the many components of your practice compare to the expectations of dental professionals, regulatory agencies, dental educators and Delta Dental.

Your QA review will focus on two parts of your practice:

1. Structural (about 20 minutes). Review of your facility and equipment, as well as emergency, sterilization and infection control protocols.
2. Records (about an hour and 45 minutes). Review of patient treatment documentation for relevance and acceptability under current standards of patient care.

The easiest way to prepare for an on-site assessment is by getting acquainted with the aspects of a QA review. Follow the checklist below to understand what will be checked during your assessment.

Structural review

The structural review involves an assessment of the facility and equipment, as well as sterilization protocols.

Facility and equipment

• Facility is clean and well maintained.
• Dentist name and office hours are posted.
• Procedure manual includes protocols for appointments, complaints, broken appointments and specialty referrals.
• Accommodations exist for patients with disabilities, such as wheelchair access and a grab bar in the restroom.
• Waterlines have anti-retraction valves installed and are maintained with properly flushed handpieces.

Radiology

• Certificates are current, and equipment inspection dates are posted.
• Lead (or lead-equivalent) apron with thyroid collar is used.

Sterilization and infection control

• Staff is trained in infection control standards, and procedural logs are kept.
• Gloves, masks, protective attire and eyewear are used appropriately.
• Weekly biologic monitoring is conducted and records are kept.
• Instruments and handpieces are properly sterilized, stored and labeled.

Safety and emergency procedures/equipment

• Drugs, syringes and needles are properly stored, and a log is kept of drugs dispensed on site.
• Required certifications are up to date.
• A modern evacuation system exists for nitrous oxide.
• Written office protocol includes staff responsibilities for evacuating patients in emergencies or natural disasters. The evacuation plan with clearly marked exits is displayed.
• An active contact system can reach the dentist 24/7.
• A portable emergency oxygen is available, full and there is a positive pressure valve and/or Ambu bag; staff are trained in its use.
• Mercury hygiene and safety requirements are observed.
• Medical emergency kit is up to date.

Records review

The records review involves a review of your patient care documentation.

Medical and dental history

• Medical history forms include yes/no questions, identify patient’s existing conditions and contain comprehensive health information.
• Dental history includes baseline information, TMJ/occlusion status, appliances, periodontal condition and results of soft tissue/oral cancer exam.

Treatment notes

• Progress and treatment notes are legible and in ink.
• Included, as appropriate, are: 
  • Referrals to specialists
  • Records forwarded or received
  • Anesthetic used (type, amount and concentration of any vasoconstrictor)
  • Medications prescribed
  • Laboratory instructions

Quality of care

• Professionally acceptable standards of care are observed for: 
  • X-rays — adequate number, appropriate frequency, of diagnostic value, mounted and labeled
  • Treatment plan — in ink, consistent with diagnosis and exam findings, alternative and elective treatment documented with the patient’s choice and reason
  • Treatment sequence — in order of need
  • Informed consent — documentation that treatment plan was reviewed and patient understands risks, benefits, alternatives and costs; any refusal of recommended care is documented

Outcomes of care

• Patient records demonstrate effectiveness of preventive care.
• Overall comprehensive documentation demonstrates that treatment was provided as appropriate, including: 
  • Good prognosis for appropriate longevity
  • Evidence of need (x-rays, pocket charting, etc.)
  • Minimal unplanned treatment or retreatment
  • Referral to a specialist in a timely manner
  • Post-operative instruction given
  • Follow-up (pocket charting, x-rays, etc.)

After your review, you’ll be notified of the findings by mail. If you fail any part of the inspection, you’ll be asked to respond to show that you’ve corrected the error. Outstanding errors or repeated failures on follow up inspections may result in a referral to Delta Dental’s Peer Review Committee (PRC).

This list highlights just a few aspects of a QA review and is a useful tool to help you review your practice through the eyes of the QA examiner. Please refer to the Quality Management section of the Delta Dental Dentist Handbook for information on the Quality Assessment process and a list of all requirements. Together with your staff, you can evaluate your office policies and procedures and be even better prepared for a future on-site QA review. For more posts about QA reviews, check out the quality assessment category.