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Using Insured Patients’ Experiences as a Gauge of Dental Care Quality

Background. There is no standard, nonproprietary method for providing national benchmarks of dental care quality as described by patients. The purpose of this research was to develop such a tool following guidelines of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) initiative.

Methods. The authors identified domains of dental care quality via qualitative methods, including a literature review, stakeholder interviews and focus groups with beneficiaries, and they cognitively tested draft questions with patients to yield a pilot survey. Psychometric analyses of pilot data (n = 3,264) identified summary indexes and guided survey revisions. The authors used two waves of subsequent data collection (n = 4,221) to test the validity of the revised survey.

Results. The mean response rate across three rounds of data collection was 51 percent. Statistical analysis indicated that 17 questions could be reliably collapsed into three composite measures: "Care From Dentist and Staff" (reliability = 0.89, scaling success = 100 percent); "Access to Dental Care" (reliability = 0.78, scaling success = 100 percent); and "Dental Plan Coverage/Service" (reliability = 0.84, scaling success = 100 percent).

Conclusions. The validity of the survey was supported in mail and Internet modes for the American English language, and the instrument was approved by the CAHPS consortium for distribution as the CAHPS Dental Plan Survey.

Practice Implications. A tool is available now for assessing dental care quality by measuring adult patients’ experiences with their dental care and coverage. The authors tested this instrument only in a population with third-party coverage, however, which is a potential limitation that should be considered.

Key Words: Dental care quality; dental plan quality; CAHPS; patient surveys; patient satisfaction; quality benchmarking

Abbreviations: AHRQ: Agency for Healthcare Research and Quality. • AIR: American Institutes for Research. • CAHPS: Consumer Assessment of Healthcare Providers and Systems. • CFA: Confirmatory factor analysis. • CFI: Comparative fit index. • EFA: Exploratory factor analyses. • GED: General Educational Development. • NNFI: Nonnormed fit index. • RMSEA: Root mean square error of approximation.