The hospital-sponsored ambulatory dental services program, Part II: An evaluation of dental services

This paper examines the appropriateness and continuity of dental care rendered by the 25 hospital facilities participating in the Hospital-Sponsored Ambulatory Dental Services Program, a $10 million effort established by the Robert Wood Johnson Foundation from 1979 to 1983. Record review data on 5,200 patients in 13 of the hospitals show that a substantially greater number of patients entered as episodic users of the system in the final phase of the evaluation than in the baseline visit; fewer of these episodic patients made the transition to initial care in the final phase. A followup study on baseline patients indicates that only 28% of the sample had a visit after the year of first contact. The trend toward episodic care is reflected in a reduced amount of preventive and operative services from baseline to final assessments. Compared with a study of private practices in California, the emphasis on surgery in the hospitals is dramatic: a dental patient accessing a hospital clinic will lose approximately one tooth as compared with a half tooth in private practice. Private practices also perform more crown and fixed partial denture services and more services across-the-board than the hospital clinics. Telephone interviews show that overall patient satisfaction with the hospital dental services remained high during the study (87% to 89%). Fewer patient in the final sample, however, planned to return to the hospital for all or part of their care. These findings reveal that continuity of care is a problem for hospital dental clinics. The preponderance of episodic care raises questions as to the breadth of experience offered by these hospitals to general practice residents.