The hospital-sponsored ambulatory dental services program, part I: an evaluation of patient access

This article describes patient access to the Hospital-Sponsored Ambulatory Dental Services Program (HSADSP), a 4-year effort initiated in 1979 by the Robert Wood Johnson Foundation. A major goal of the program was to provide comprehensive general dental care to underserved populations. Independent samples of 2,600 patients each, in 13 of the hospitals (200 patients per institution), were assessed at the beginning and end of the program to ascertain changes in dental care resulting from the expansion of the dental facilities and the support of general practice residents. According to data compiled by the evaluation team, patient volume increased by more than 15% from the first year of the program (baseline sample) to the period preceding the fourth year (final sample). Although the proportion of underserved patients accessing the program was high in both periods, the percentages of “special” patients, minority members, and the poor all decreased slightly during the study. At the same time, the proportion of episodic patients increased by 15% and the number of patients with private dental insurance increased at a lower rate than the national average. Counter to prior expectations, only about 20% to 35% of new patients accessing the dental clinics used the sponsoring hospital as a source of medical care, either inpatient or outpatient. The gains made in patient access to the HSADSP were lower than anticipated. There is little evidence that many of these hospital-based general practices and residency programs would be able to sustain economic viability without innovative financing techniques or direct subsidy.