Kushman J E, Perry D A, Freed J R
College of Human Resources, University of Delaware, Newark, USA.
J Dent Hyg. 1996 Sep-Oct;70(5):194-205.
This paper presents business characteristics of ten experimental independent dental hygiene practices operating in California between 1987 and 1990. Sixteen dental hygienists participated in the experiment, the Health Manpower Pilot Project 139 (HMPP 139). HMPP 139 dental hygienists wanted to work independently in traditional office-based settings, institutional settings, and other arrangements. They worked in group and solo practices, on a full- or part-time basis.
Data were collected from the HMPP 139 practices on services provided, patient visits, fees charged, referrals to dentists, acceptance of Medicaid patients, and services to organizational clients. Data collection methods varied, depending on the question addressed. Surveys of dentists' offices provided data on fees and Medicaid policies for comparison with the independent dental hygiene practices.
All experimental practices attracted new patients for each quarter in operation. These practices mostly provided prophylaxis treatments; however, a wide variety of services was provided. Fees charged in HMPP 139 office-based practices were less than comparable fees charged in dentists' offices. At least one-third of patients in the HMPP 139 office-based settings received a referral to or an opinion about a dentist from the dental hygienist. HMPP 139 practices were more available to Medicaid patients than were California dentists offices. Each experimental independent practice provided care to at least one client in a nontraditional setting.
The HMPP 139 practices consistently attracted new patients. This suggests independent practice for dental hygienists may be a viable and flexible alternative if the practices can stabilize total patients at a sufficiently high level. An independent practice alternative might increase access to care, contain fees, and direct the flow of patients to dentists. Further study is needed to test these findings.
本文介绍了1987年至1990年间在加利福尼亚州运营的十家实验性独立口腔卫生保健机构的业务特点。16名口腔保健员参与了该实验，即卫生人力试点项目139（HMPP 139）。HMPP 139的口腔保健员希望在传统的基于办公室的环境、机构环境及其他安排中独立工作。他们以团队或个体形式执业，工作方式有全职或兼职。
从HMPP 139机构收集了有关所提供服务、患者就诊情况、收费、转诊至牙医、接受医疗补助患者情况以及为机构客户提供服务等方面的数据。数据收集方法因所涉及的问题而异。对牙医诊所的调查提供了有关收费和医疗补助政策的数据，以便与独立口腔卫生保健机构进行比较。
所有实验性机构在运营的每个季度都吸引了新患者。这些机构大多提供预防性治疗；然而，也提供了各种各样的服务。HMPP 139基于办公室的机构所收取的费用低于牙医诊所收取的可比费用。在HMPP 139基于办公室的环境中，至少三分之一的患者从口腔保健员那里获得了转诊至牙医或关于牙医的建议。HMPP 139机构比加利福尼亚州的牙医诊所更愿意接纳医疗补助患者。每个实验性独立机构都至少在一个非传统环境中为一位客户提供了护理。
HMPP 139机构持续吸引了新患者。这表明，如果口腔保健员的执业机构能够将患者总数稳定在足够高的水平，那么独立执业可能是一种可行且灵活的选择。独立执业的选择可能会增加获得护理的机会、控制费用，并引导患者流向牙医。需要进一步研究来验证这些发现。
