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PubMed1989

Quality evaluation of anterior restorations in private practice.

As part of a series of postgraduate courses in Cariology for dentists, a section designed to stimulate the interest in quality evaluation of fillings was included. Thus, 75 private practitioners were asked to evaluate a number of anterior restorations on their own patients. The method used was a modification of the California Dental Association (CDA) quality evaluation system. By use of a four-graded scale the following five properties were evaluated: (1) color of the filling, (2) color of the margin, (3) surface structure and anatomic form, (4) marginal integrity, and (5) caries. The criteria were related to practical-clinical measurements. Altogether 1147 fillings were assessed, most of them 2-4 years old (n = 949). The results showed that 25 different brands had been used, of which 4 composites constituted 68% of all fillings. With the exception for one composite material, no obvious difference in the quality evaluation between the materials was observed. Of the 2-4 year old fillings, approximately every fourth was rated as "not acceptable", i.e. with need for clinical treatment "soon" or "within reasonable time". Our impression was that the system used in this study is suitable for an assessment of the quality of anterior fillings in a private practice and that it should stimulate dentists to a quality thinking in dentistry in general.

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From primary care physician employment to private practice: easing the transition.

In most cases, the practice acquisition and employment strategy of the 1990s has backfired, with acquired physician practices losing in the range of $50,000 to $100,000 or more per physician annually. There are two alternatives for addressing the operating deficits incurred from practice ownership and physician employment: (1) restructuring through the implementation of network-wide and practice-specific initiatives to improve financial performance; or (2) wholesale (i.e., all practices) or selective practice divestiture, depending on the individual practice financial performance and "fit" with the physician network strategic priorities. Unraveling a decade's worth of physician-health system relationships that are grounded by the notion of acquisition and employment is going to be a complex process for both parties. But given the magnitude of financial losses on acquired practices and the inability of health care providers to sustain future losses, there simply are not options beyond restructuring or divesting these relationships.

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