Assessment of the clinical quality of health care. Search for a reliable method.

Rating systems and criteria, developed for peer review, were used for evaluation of dental care as part of a study to determine the feasibility of using computers as a first-level screening mechanism for quality assurance. Ten dentists were trained and standardized in the use of the system, and 646 patients received full-mouth examinations by two examiners. Disagreements were resolved by joint examination. More than 22,000 individual judgments were recorded. Of all dental services evaluated, 91.5% were rated satisfactory. Data on subratings, Range of Excellence versus Range of Acceptability and Replace for Prevention (future damage likely) versus Replace Statim (damage now occurring) are also presented, together with interexaminer agreement levels. The rating system permitted full-mouth examination by two trained examiners, including resolution of disagreements, to be carried out in an average of 24 minutes. The system is suitable for verification of computer screening of treatment records for quality assurance.