The hospital administrator's expectations of the manager of a department of dentistry

This era of DRG/prospective payment systems has imposed responsibilities on hospital dental department managers that are beyond the traditional managerial functions. This paper presents ten of these additional duties for middle level managers. To survive, a hospital needs to see these responsibilities as goals and use them to formulate a plan of action.     

Coronal and root caries incidence and increments

This study reprots on coronal and root caries incidence in elderly lowans between 1987 and 1988. The sample consisted of 74 survivors ofthe lowa 65+Oral Health Study cohort who recieved oral examinations both who recieved oral examinations both in 1987 and between 1996‐98. The study found that average untreated coronal and root increments were 0.96 and 0.69 surfaces, filled increments were 18.22 and 1.28 surfaces, and combined increments were 18.3 and 1027 sufaces, respectively. Therefore. annualized untreated coronal and root increments were 0.10 and 1.07 surfaces, filled were 1.80 and 0.13 surfaces, and combined increments were 1.81 and 0.12 surfaces, respectively. The annualized attack rates were 2.13 for coronal and 0.80 for root caries. Approximately 93% of the subjects developed some new coronal and 43% some new root caries increment. Dental caries still constutute a significant problem since a large proportion of the elderly developed caries during this period. This suggests a need for improved preventive and treatment strategies for this aged population.     

Aging With Traumatic Brain Injury: Cross-Sectional Follow-Up of People Receiving Inpatient Rehabilitation Over More Than 3 Decades

Sendroy-Terrill M, Whiteneck GG, Brooks CA. Aging with traumatic brain injury: cross-sectional follow-up of people receiving inpatient rehabilitation over more than 3 decades.

Objective

To investigate aging with traumatic brain injury (TBI) by determining if long-term outcomes after TBI are predicted by years postinjury and age at injury after controlling for the severity of the injury and sex.

Design

Cross-sectional follow-up telephone survey.

Setting

Community residents who had received initial treatment in a comprehensive inpatient rehabilitation hospital.

Participants

Survivors of TBI (N=243) stratified by years postinjury (in seven 5-year cohorts ranging from 1 to over 30 years postinjury) and by age at injury (in 2 cohorts of people injured before or after age 30).

Interventions

None.

Main Outcome Measures

Measures of postconcussive symptoms, major secondary conditions including fatigue (Modified Fatigue Impact Scale), physical and cognitive activity limitations (FIM, Alertness Behavior Subscale of the Sickness Impact Profile, Medical Outcomes Study 12-Item Health Status Survey Short Form), societal participation restrictions (Craig Handicap Assessment and Reporting Technique), environmental barriers (Craig Hospital Inventory of Environmental Factors), and perceived quality of life (Satisfaction with Life Scale).

Results

Most problems identified by the outcome measures were reported by one fourth to one half of the study participants. Increasing decades postinjury predicted declines in physical and cognitive functioning, declines in societal participation, and increases in contractures. Increasing age at injury predicted declines in functional independence, increases in fatigue, declines in societal participation, and declines in perceived environmental barriers.

Conclusions

This investigation has increased our understanding of the aging process after TBI by demonstrating that both components of aging (years postinjury and age at injury) are predictive of several outcomes after TBI.     

Achievable benchmarks of care: the ABC<SUP>TM</SUP>s of benchmarking

Abstract: Benchmarking is generally considered to be an important tool for quality improvement. Traditional approaches to benchmarking have relied on subjective identification of 'leaders in the field'. We derive an objective, reproducible and attainable Achievable Benchmark of Care (ABC^TM) by measuring and analysing performance on process-of-care indicators. Three characteristics of the ABC^TM that we deem essential are: (1) benchmarks represent a measurable level of excellence; (2) benchmarks are demonstrably attainable; (3) benchmarks are derived from data in an objective, reproducible and predetermined fashion. From these characteristics it follows that (4) providers with high performance are selected to define a level of excellence in a predetermined fashion, but (5) providers with high performance on small numbers of cases do not influence unduly benchmark levels. We use the 'pared mean' to operationalize the ABC^TM. Roughly, the pared mean summarizes the performance of top-ranked providers whereby at least 10% of the patient pool across all providers is included. Bayesian estimators for adjustment of performance of providers with small sample sizes are used to rank providers. Randomized controlled trials to assess the independent effect of the ABC^TM in quality improvement projects are under way. We have developed a methodology objectively and reproducibly to derive a level of excellent, attainable performance, based on measured performance by a group of providers. The ABC^TM can be applied to groups of providers in communities, to institutions and departments within them, or to individual practitioners.