Outcome measures for oral health based on clinical assessments and claims data: feasibility evaluation in practice

R. Hummel; J. Bruers; O. van der Galiën; W. van der Sanden; G. van der Heijden

doi:10.1186/s12903-017-0410-5

Outcome measures for oral health based on clinical assessments and claims data: feasibility evaluation in practice

R. Hummel, J. Bruers, O. van der Galiën, W. van der Sanden, G. van der Heijden

Oral Public Health

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Background: It is well known that treatment variation exists in oral healthcare, but the consequences for oral health are unknown as the development of outcome measures is still in its infancy. The aim of this study was to identify and develop outcome measures for oral health and explore their performance using health insurance claims records and clinical data from general dental practices. Methods: The Dutch healthcare insurance company Achmea collaborated with researchers, oral health experts, and general dental practitioners (GDPs) in a proof of practice study to test the feasibility of measures in general dental practices. A literature search identified previously described outcome measures for oral healthcare. Using a structured approach, identified measures were (i) prioritized, adjusted and added to after discussion and then (ii) tested for feasibility of data collection, their face validity and discriminative validity. Data sources were claims records from Achmea, clinical records from dental practices, and prospective, pre-determined clinical assessment data obtained during routine consultations.
Results: In total eight measures (four on dental caries, one on tooth wear, two on periodontal health, one on retreatment) were identified, prioritized and tested. The retreatment measure and three measures for dental caries were found promising as data collection was feasible, they had face validity and discriminative validity. Deployment of these measures demonstrated variation in clinical practices of GDPs. Feedback of this data to GDPs led to vivid discussions on best practices and quality of care. The measure 'tooth wear' was not considered sufficiently responsive; 'changes in periodontal health score' was considered a controversial measure. The available data for the measures 'percentage of 18-year-olds with no tooth decay' and 'improvement in gingival bleeding index at reassessment' was too limited to provide accurate estimates per dental practice.
Conclusions: The evaluated measures 'time to first restoration', 'distribution of risk categories for dental caries', 'filled-and-missing score' and 'retreatment after restoration', were considered valid and relevant measures and a proxy for oral health status. As such, they improve the transparency of oral health services delivery that can be related to oral health outcomes, and with time may serve to improve these oral health outcomes.

Original language	English
Article number	125
Number of pages	18
Journal	BMC Oral Health
Volume	17
Issue number	1
DOIs	https://doi.org/10.1186/s12903-017-0410-5
Publication status	Published - 5 Oct 2017

Funding

The authors would like to thank the participating GDPs for delivering their data and vivid contribution to the discussions. We thank Melanie Nieuweboer from the ANT (Association of Dutch Dentists) for participating in the expert group. We acknowledge the following workers and formal workers of Achmea for their contributions in the project team: Hieke Visser, Paulien Brunings, Erik de Vlieger (project managers), Emőke Jakab (researcher/data analyst), and Karin Hoekstra (senior user). We also appreciate the support from Merijn Stouten and Marloes Hagemans from Gupta Strategists and the statistical advice from Irene Aartman from ACTA. We thank Professor Neal Maskrey (Visiting Professor of Evidence-informed Decision Making, Keele University, UK) for his help with the revision of the final draft of the manuscript. Finally, we would like to express our gratitude to Achmea for funding this study and IQ Healthcare (Radboud university medical center Nijmegen, Radboud Institute for Health Sciences, the Netherlands) for the identification of described outcome measures on oral healthcare in MEDLINE-PubMed and websites of relevant national and international organizations.

Funders	Funder number
Alliance for California Traditional Arts

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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title = "Outcome measures for oral health based on clinical assessments and claims data: feasibility evaluation in practice",

abstract = "Background: It is well known that treatment variation exists in oral healthcare, but the consequences for oral health are unknown as the development of outcome measures is still in its infancy. The aim of this study was to identify and develop outcome measures for oral health and explore their performance using health insurance claims records and clinical data from general dental practices. Methods: The Dutch healthcare insurance company Achmea collaborated with researchers, oral health experts, and general dental practitioners (GDPs) in a proof of practice study to test the feasibility of measures in general dental practices. A literature search identified previously described outcome measures for oral healthcare. Using a structured approach, identified measures were (i) prioritized, adjusted and added to after discussion and then (ii) tested for feasibility of data collection, their face validity and discriminative validity. Data sources were claims records from Achmea, clinical records from dental practices, and prospective, pre-determined clinical assessment data obtained during routine consultations. Results: In total eight measures (four on dental caries, one on tooth wear, two on periodontal health, one on retreatment) were identified, prioritized and tested. The retreatment measure and three measures for dental caries were found promising as data collection was feasible, they had face validity and discriminative validity. Deployment of these measures demonstrated variation in clinical practices of GDPs. Feedback of this data to GDPs led to vivid discussions on best practices and quality of care. The measure 'tooth wear' was not considered sufficiently responsive; 'changes in periodontal health score' was considered a controversial measure. The available data for the measures 'percentage of 18-year-olds with no tooth decay' and 'improvement in gingival bleeding index at reassessment' was too limited to provide accurate estimates per dental practice. Conclusions: The evaluated measures 'time to first restoration', 'distribution of risk categories for dental caries', 'filled-and-missing score' and 'retreatment after restoration', were considered valid and relevant measures and a proxy for oral health status. As such, they improve the transparency of oral health services delivery that can be related to oral health outcomes, and with time may serve to improve these oral health outcomes.",

author = "R. Hummel and J. Bruers and {van der Gali{\"e}n}, O. and {van der Sanden}, W. and {van der Heijden}, G.",

year = "2017",

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doi = "10.1186/s12903-017-0410-5",

language = "English",

volume = "17",

journal = "BMC Oral Health",

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T1 - Outcome measures for oral health based on clinical assessments and claims data

T2 - feasibility evaluation in practice

AU - Hummel, R.

AU - Bruers, J.

AU - van der Galiën, O.

AU - van der Sanden, W.

AU - van der Heijden, G.

PY - 2017/10/5

Y1 - 2017/10/5

N2 - Background: It is well known that treatment variation exists in oral healthcare, but the consequences for oral health are unknown as the development of outcome measures is still in its infancy. The aim of this study was to identify and develop outcome measures for oral health and explore their performance using health insurance claims records and clinical data from general dental practices. Methods: The Dutch healthcare insurance company Achmea collaborated with researchers, oral health experts, and general dental practitioners (GDPs) in a proof of practice study to test the feasibility of measures in general dental practices. A literature search identified previously described outcome measures for oral healthcare. Using a structured approach, identified measures were (i) prioritized, adjusted and added to after discussion and then (ii) tested for feasibility of data collection, their face validity and discriminative validity. Data sources were claims records from Achmea, clinical records from dental practices, and prospective, pre-determined clinical assessment data obtained during routine consultations. Results: In total eight measures (four on dental caries, one on tooth wear, two on periodontal health, one on retreatment) were identified, prioritized and tested. The retreatment measure and three measures for dental caries were found promising as data collection was feasible, they had face validity and discriminative validity. Deployment of these measures demonstrated variation in clinical practices of GDPs. Feedback of this data to GDPs led to vivid discussions on best practices and quality of care. The measure 'tooth wear' was not considered sufficiently responsive; 'changes in periodontal health score' was considered a controversial measure. The available data for the measures 'percentage of 18-year-olds with no tooth decay' and 'improvement in gingival bleeding index at reassessment' was too limited to provide accurate estimates per dental practice. Conclusions: The evaluated measures 'time to first restoration', 'distribution of risk categories for dental caries', 'filled-and-missing score' and 'retreatment after restoration', were considered valid and relevant measures and a proxy for oral health status. As such, they improve the transparency of oral health services delivery that can be related to oral health outcomes, and with time may serve to improve these oral health outcomes.

AB - Background: It is well known that treatment variation exists in oral healthcare, but the consequences for oral health are unknown as the development of outcome measures is still in its infancy. The aim of this study was to identify and develop outcome measures for oral health and explore their performance using health insurance claims records and clinical data from general dental practices. Methods: The Dutch healthcare insurance company Achmea collaborated with researchers, oral health experts, and general dental practitioners (GDPs) in a proof of practice study to test the feasibility of measures in general dental practices. A literature search identified previously described outcome measures for oral healthcare. Using a structured approach, identified measures were (i) prioritized, adjusted and added to after discussion and then (ii) tested for feasibility of data collection, their face validity and discriminative validity. Data sources were claims records from Achmea, clinical records from dental practices, and prospective, pre-determined clinical assessment data obtained during routine consultations. Results: In total eight measures (four on dental caries, one on tooth wear, two on periodontal health, one on retreatment) were identified, prioritized and tested. The retreatment measure and three measures for dental caries were found promising as data collection was feasible, they had face validity and discriminative validity. Deployment of these measures demonstrated variation in clinical practices of GDPs. Feedback of this data to GDPs led to vivid discussions on best practices and quality of care. The measure 'tooth wear' was not considered sufficiently responsive; 'changes in periodontal health score' was considered a controversial measure. The available data for the measures 'percentage of 18-year-olds with no tooth decay' and 'improvement in gingival bleeding index at reassessment' was too limited to provide accurate estimates per dental practice. Conclusions: The evaluated measures 'time to first restoration', 'distribution of risk categories for dental caries', 'filled-and-missing score' and 'retreatment after restoration', were considered valid and relevant measures and a proxy for oral health status. As such, they improve the transparency of oral health services delivery that can be related to oral health outcomes, and with time may serve to improve these oral health outcomes.

U2 - 10.1186/s12903-017-0410-5

DO - 10.1186/s12903-017-0410-5

M3 - Article

SN - 1472-6831

VL - 17

JO - BMC Oral Health

JF - BMC Oral Health

IS - 1

M1 - 125

ER -

Outcome measures for oral health based on clinical assessments and claims data: feasibility evaluation in practice

Abstract

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UN SDGs

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