The Journal of the American College of Dentists最新文献

The Association of Dental Support Organizations is a recently formed association of 33 companies representing a range of management and support services for dental practices. These organizations do not engage in the practice of dentistry, although in some cases they operate as holding companies for practices that do, thus separating the legal responsibility of providing treatment from the management and flow of funds. This report summarizes some of the recent trends in oral health care and dentists' practice patterns that are prompting the increased prevalence of this model. The general functioning of the DSO model is described, including some common variations, and the core values of ADSO are featured.

The American College of Dentists is embarking on a multiyear project to improve ethics in dentistry. Early indications are that the focus will be on actual moral behavior rather than theory, that we will include organizations as ethical units, and that we will focus on building moral leadership. There is little evidence that the "telling individuals how to behave" approach to ethics is having the hoped-for effect. As a profession, dentistry is based on shared trust. The public level of trust in practitioners is acceptable, but could be improved, and will need to be strengthened to reduce the risk of increasing regulation. While feedback from the way dentists and patients view ethics is generally reassuring, dentists are often at odds with patients and their colleagues over how the profesion manages itself. Individuals are an inconsistent mix of good and bad behavior, and it may be more helpful to make small improvements in the habits of all dentists than to try to take a few certifiably dishonest ones off the street. A computer simulation model of dentistry as a moral community suggests that the profession will always have the proportion of bad actors it will tolerate, that moral leadership is a difficult posture to maintain, that massive interventions to correct imbalances through education or other means will be wasted unless the system as a whole is modified, and that most dentists see no compelling benefit in changing the ethical climate of the profession because they are doing just fine. Considering organiza-tions as loci of moral behavior reveals questionable practices that otherwise remain undetected, including moral distress, fragmentation, fictitious dentists, moral fading, decoupling, responsibility shifting, and moral priming. What is most needed is not phillosophy or principles, but moral leadership.

Federally Qualified Health Centers serve, on a "cost-to-provide-care basis," low-income and other patients who cannot use private pay facilities. This is a safety-net care system that is much more comprehensive and less expensive than emergency room visits. The existence of an FQHC in a community partially removes the pressure on fee-for-service providers to make arrangements for treating dentally disadvantaged individuals. Increases in federal spending for dental services have recently outpaced declines in out-of-pocket private pay spending and sluggish improvements in insurance coverage.

The standard of care is a legal construct, a line defined by juries, based on expert testimony, marking a point where treatment failed to meet expectations for what a reasonable professional would have done. There is no before-the-fact objective definition of this standard, except for cases of law and regulation, such as the Occupational Safety and Health Admintration (OSHA). Practitioners must use their judgment in determining what would be acceptable should a case come to trial. Professional codes of conduct and acting in the patient's best interests are helpful guides to practicing within the standard of care. Continuing education credit is available for this and the following article together online at www.dentalethics.org for those who wish to complete the quiz and exercises associated with them (see Course 22).

Background and objectives: The objective of this retrospective study was to determine if the collection rates for dental related visits to the emergency department (ED) are less than collection rates for ED visits for other problems.

Methods: Data were analyzed from one Kentucky hospital's electronic health record system from April 2010 to April 2012. Collection rates for patients who received care in the ED for uncomplicated dental problems were compared to collection rates for all patients who received care in the ED for any reason.

Results: Each month during the study period, an average of 77 patients presented to the ED for dental problems. Compensation rates for physician fees were 9.8% for dental related care and 39% for all patients who received care for any reason. Compensation rates for hospital fees were 16% for dental related care and 20.1% for all patients who received care for any reason. Uninsured patients accounted for 68.8% of physician fees and 62.4% of hospital fees for dental related care.

Conclusions: Using the ED as a dental safety net is costly to the patient because the underlying problem is typically not resolved and costly to the hospital because of very low collection rates. In addition, other patients who present to the ED for non-dental, high acuity problems may have delayed care or no care because of the number of patients using the ED for dental pain.

Published research in English-language journals are increasingly required to carry a statement that the study has been approved and monitored by an Institutional Review Board in conformance with 45 CFR 46 standards if the study was conducted in the United States. Alternative language attesting conformity with the Helsinki Declaration is often included when the research was conducted in Europe or elsewhere. The Helsinki Declaration was created by the World Medical Association in 1964 (ten years before the Belmont Report) and has been amended several times. The Helsinki Declaration differs from its American version in several respects, the most significant of which is that it was developed by and for physicians. The term "patient" appears in many places where we would expect to see "subject." It is stated in several places that physicians must either conduct or have supervisory control of the research. The dual role of the physician-researcher is acknowledged, but it is made clear that the role of healer takes precedence over that of scientist. In the United States, the federal government developed and enforces regulations on researcher; in the rest of the world, the profession, or a significant part of it, took the initiative in defining and promoting good research practice, and governments in many countries have worked to harmonize their standards along these lines. The Helsinki Declaration is based less on key philosophical principles and more on prescriptive statements. Although there is significant overlap between the Belmont and the Helsinki guidelines, the latter extends much further into research design and publication. Elements in a research protocol, use of placebos, and obligation to enroll trials in public registries (to ensure that negative findings are not buried), and requirements to share findings with the research and professional communities are included in the Helsinki Declaration. As a practical matter, these are often part of the work of American IRBs, but not always as a formal requirement. Reflecting the socialist nature of many European counties, there is a requirement that provision be made for patients to be made whole regardless of the outcomes of the trial or if they happened to have been randomized to a control group that did not enjoy the benefits of a successful experimental intervention.

The dramatic increase in broadband connectivity is opening up the possibility for using telehealth-connected teams in an improved system for charity care. The Virtual Dental Home demonstration taking place in California provides a model for the development and deployment of such teams. Teams using telehealth connections to provide oral health care can transform episodic or one-time visits into an ongoing system of care with a much greater emphasis on prevention and early intervention techniques and a greater likelihood of improved oral health for the population.

The U.S. Supreme Court heard oral arguments this fall in a case involving the North Carolina State Board of Dental Examiners that could have a dramatic impact on how states license and regulate professionals in America. This paper briefly describes the facts of the case and the history of professional licensing in America and then discuses and evaluates the potential impact of the various legal arguments presented by the parties in the case.

Selling a practice is not like selling a car; many lives are bound up in the transaction This is a personal narrative about career planning and circumstances. Without the author's succession of detailed plans, he never would have been sensitive enough to the need for nearly continuous adjustments. In the end, the true value of the practice was not measured in dollars.