Relationships among structure, process, and outcome scores derived from evaluations of 300 general dental practices

Analyses were undertaken to examine relationships among measures of structure, process, and outcome using data obtained during field testing of the Development of Evaluation Methods and Computer Applications in Dentistry (DEMCAD) office assessment instrument in 300 general dental practices. Correlation coefficients between scores for the structure dimension and scores for the process/outcome dimensions were 0.50 and 0.40, respectively, while process and outcome dimension scores were correlated at an even higher level (r = 0.79). Thus the DEMCAD instrument demonstrated a relatively high degree of interrelationship among these three major dimensions compared to other reports in the health care evaluation literature. Additional analyses were conducted to compare relationships between structure and process measures and various components of outcome, and to compare results across different types of practices (urban group, rural and urban nongroup). Correlations between the patient satisfaction component of outcome and scores for the structure/process dimensions were considerably lower than the corresponding correlations involving outcome components other than patient satisfaction. Ordinary least squares regression models demonstrated that structure scores were not significantly related to outcomes when controlling for process and that relationships were quite consistent across practice types.