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Three Dimensions of Health Care Delivery Structure Process and Outcomes

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    Comparison and Contrast of the CDHO Quality Improvement Program and The ‘ADPIE’ Process of Care

    The key priorities in the field of health care services are these: the quality of the service; the safety of the clients; and also the clients’ satisfaction. Experts or practitioners in this area of profession should always follow the standards and rules set by the governing body. They should always consult to the written guidelines to guarantee that their skills, knowledge, and competence on health care delivery are of the standards established by experts in the field. These rules and standards are established essentially for registered practitioners to make sure that the quality of the services they offer to their clients is maintained. These standards also provide a reference to make further improvements on the standards and guidelines of health care services.

    The Quality Improvement Program, a part of the College of Dental Hygienists of Ontario’s (CDHO) Quality Assurance Program, comprises an on-going evaluation system that centers on models of behavior rather than focusing on remote instances of behavior (for example, incident reporting). The program also acts as a system for evaluating the quality of care and applying and assessing changes in the patient care delivery system to at least maintain or further improve the quality of health care delivery. One Quality Improvement Program should incorporate three dimensions of health care delivery: 1) structure; 2) process; and 3) outcomes. The first dimension, which is the structure, considers the equipment to be used, administration, personnel, and dental records. The process dimension comprises the issues regarding patient care such as diagnosis, sequence and appropriateness of care, and also technical skills. The outcomes dimension considers the product and result of care. Overall, the Quality Improvement Program process comprises a continuous, cyclic procedure of assessment, planning, implementation, and evaluation.

    Also, as component of the Dental Hygiene Standards of Practice, Code of Ethiscs, Records Regulation & Standard for Self-Initiation, CDHO has also formulated a Guideline for Best Practice in Initiating Dental Hygiene Care. This guideline talks about the ADPIE (assessment, diagnosis, planning, implementation, evaluation) process in practicing dental care services. The ADPIE process guideline stresses that the foundation of all dental care services should be the Dental Hygiene Process of Care.

    The ADPIE process of care, compared to the Quality Improvement Program, talks about the detailed practices that should be followed properly by registrants during the delivery of care itself. It tackles the rules and principles on how should practitioners deal with their clients on different specific situations. As an addition, the ADPIE process of care points out that each practitioner should be responsible of the planning of necessary activities of treatments, following the CDHO Records Regulation.

    A similarity between the Quality Improvement Program and the Guideline for Best Practice is that they are both in accordance to the CDHO codes. These two guidelines and principles are used by the CDHO governing board with the dental health care practitioner to maintain and/or further improve the quality of dental hygiene services in Ontario. Unlike the Guideline for Best Practice (the ADPIE process), the Quality Improvement Program focuses on improving dental health care by assessing the quality of the data from former incidents. The Quality Improvement Program develops strategies by evaluating former cases of dental health service to further improve the quality of practitioners in Ontario. On the other hand, the ADPIE process serves as a manual on how to deal with the specifics of the dental care process itself.


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