Performance Evaluation of Oral Health Teams in Brazil: An Item Response Theory Approach

Abstract

Access to quality healthcare is an essential component of health policy. This cross-sectional study describes the actions performed by Brazilian Oral Health Teams (OHTs) analyzed in the National Program for Improving Access and Quality of Primary Care and the relationship of contextual aspects. A total of 22,993 OHTs that participated in the third cycle of the referred program were evaluated using a structured questionnaire. Thirteen procedures (items) related to spontaneous dental care and preventive, surgical, restorative, prosthetic, and oral cancer prevention or diagnosis were assessed. Item response theory was used to estimate the performance scores of OHTs, based on 13 items. The relationship between performance scores and contextual variables in Brazilian regions was analyzed by thematic maps and Spearman correlation (p < 0.05). The highest difficulty parameters were for questions related to prosthetics (b = 0.879) and actions for oral cancer (b = 2.922). The 13 items were more appropriate to discriminate the teams with lower performance and relatively ineffective in differentiating those with better performance. A direct relationship with the Human Development Index (rs = 0.249; p = 0.004) and an indirect relationship with the Gini Index (rs = −0.482; p < 0.001) were found. Contextual aspects presented a relationship with the performance of the Brazilian OHTs. The evaluated items showed some potential to discriminate the performance of OHTs since many of the evaluated dental procedures are performed by most of the teams.