MANAGEMENT INFORMATION SYSTEM OVERVIEW

The quantitative assessment of clinical performance is a requisite need in order to manage a program successfully. In 1981, Region II of the Public Health Service initiated a comprehensive dental management information system (MIS) utilizing a relative value system (RVS) as the key metric in program assessment. The purpose of using the RVS was to quantify the output of services. Prior to this, the encounter or visit was used, however, an encounter cannot be quantified in terms of time. The RVS utilizes a time-based relative value unit (RVU). Services were given a value of RVUs based on the average time needed to provide a service. Literature reviews, questionnaires, and focus groups were used to determine the RVUs for each service.

Ten indicators were selected for this assessment. These were chosen as a result of an earlier study that identified these indicators utilizing statistical methodologies. The indicators were divided into two general categories: nine performance indicators and the profile of service indicators.

DEFINITION OF TERMS

  1. Data – Collection of facts from which conclusions can be drawn.
  2. Indicator – A number derived from a series of observed facts designed to highlight specific characteristics of systems. An indicator quantifies an activity. Indicators are often presented as rates and ratios. Rates and ratios provide a basis for comparison, which cannot be done with a number like a target.
  3. Rate – The numerator is included in the denominator. Examples include percent, infant mortality rate (deaths at birth over total births – usually presented as deaths at birth over 1000 births), and unemployment rate (individuals out of work over the e5/30/07tio – The numerator is different from the denominator, the relationship between two quantities. Examples include miles per hour, cost per capita, and price to earnings.
  4. Standard – A number as to what an indicator is judged – a benchmark or point of reference.
  5. Relative Value Unit (RVU) – A metric used to measure the output of services. The RVU is based on the average amount of time needed to complete a service. One RVU equals ten minutes of a dentist’s time and fifteen minutes of a hygienist’s time. Traditionally, encounters have been used as a metric to determine productivity. The problem with the encounter is that it cannot be quantified to determine the amount of work done.
  6. Encounter – A visit with a health services provider. Encounters are best used to determine the effectiveness of the appointment system.
  7. Full-time Equivalent (FTE) –A full-time employee is one who works a five-day, 35-hour week. This includes time off for vacations, personal days, and sick days.
    9. User – A non-duplicated person who uses the health facility for one or more encounters.

INDICATORS

A. Performance Indicators

  1. Relative Value Units (RVUs) per Hour – This measures the output of the dental provider – dentist and dental hygienist – in terms of service units and is a measure of productivity.
  2. Encounters per Hour – This measures the number of encounters per hour and is a measure of the effectiveness of the appointment system.
  3. RVUs per Encounter – This measures the output of services provided at each encounter. This quantifies the amount of work completed per encounter.
  4. Encounters per User – This is the number o5/30/07s per FTE dentist – The number of users treated by an FTE dentist during a twelve-month period.
  5. RVUs per User – The amount of work completed on each user. This is a measure of the comprehensiveness of care.
  6. Cost per Encounter – The cost of providing an encounter.
  7. Cost per RVU – The cost of providing one RVU of service.
  8. Cost per User – The total cost of treating a patient. This is the basis for capitation payments.

B. Profile of Service Indicators:
These are measured in percent of time spent in providing specific categories of dental care as defined by the American Dental Association. This qualifies the type of care provided. The categories are:

  • Diagnosis – examinations, radiographs
  • Prevention – cleanings, fluoride treatments
  • Restorative – fillings, crowns
  • Endodontics – root canal therapy
  • Periodontics – treatment of gingivitis and periodontal disease
  • Oral surgery – extraction of teeth
  • Adjunctive – treatment of emergencies, counseling

STANDARDS

A. Performance Indicators

  1. Relative Value Units (RVUs) per Hour – A minimum of 5 RVUs for a dentist 3.5 RVUs for a dental hygienist. This is the equivalent of 50 minutes of work per hour. The dental hygienist is less than the dentist because the expense of the hygienist is about one-third less than a dentist. As a result, the cost per RVU is equivalent for both provider types.
  2. Encounters per Hour – A minimum of 1.6 encounters per hour or an average of 40 minutes per encounter for both dentists and dental hygienists.
  3. RVUs per Encounter – A minimum of 3 per dentist and 2 per hygienist. This equates to 30 minutes of work per encounter.
  4. Encounters per User – A minimum of 2 e5/30/07ntist – 1,000-1,200 users per FTE dentist.
  5. RVUs per User – A range of 5-7 RVUs with a mean of 6.
  6. Cost per RVU – $25.00 to $30.00 per RVU for direct expenses (personnel, OTPS).
  7. Cost per Encounter – $75.00 – $90.00 for direct expenses (personnel, OTPS).
  8. Cost per User – $150 – $200 per user for direct expenses (personnel, OTPS).

B. Profile of Service Indicators:
These are variable in regard to the mission of the program and the patients seen. In general, the emphasis is to identify those children at need and provide the treatment. The profile uses a percent of RVUs for each category of service. Experience with a children’s program is best demonstrated in Children’s Dental Program in New York City as presented in the article entitled “Delivery of Comprehensive Children’s Dental Services Using Portable Dental Clinics in NYC Public Schools – A Six-Year Analysis” by Neal Herman; Murray Rosenthal; D. Mercedes Franklin; in the New York State Dental Journal, April 1997. The percent of time spent in the following indicators is:

  • Diagnosis 22% – 27%
  • Prevention 12% – 29%
  • Restorative 25% – 44%

STRUCTURE OF THE MANAGEMENT INFORMATION SYSTEM

Input Documents: Date is retrieved from several sources: the registration log; the encounter form; accounting data; and budgets.
Output Tables: Each program has to determine the tables needed to assess the dental program. The tables provided give an exhaustive look at a program. It is recommended that all ten indicators be used for program assessment.