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. 2017 Oct 5;17(1):125.
doi: 10.1186/s12903-017-0410-5.

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

Riët Hummel  1   2 , Josef Bruers  3   4 , Onno van der Galiën  5 , Wil van der Sanden  6 , Geert van der Heijden  3
Affiliations

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

Riët Hummel et al. BMC Oral Health. .

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.

Keywords: Dental caries; Oral health; Outcome assessment health care; Physician’s practice patterns; Quality improvement; Quality measures.

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Conflict of interest statement

Ethics approval and consent to participate

This study concerns a Health Services Research project which under the Medical Research Involving Human Subjects Act (WMO) is not considered as medical-scientific research. (www.ccmo.nl/en/non-wmo-research http://www.ccmo.nl/en/types-of-research) And as such, neither is ethics clearance from a Medical Ethics Research Board, nor is individual consent of patients required.

A Trusted Third Party has taken care of handling, processing and analyzing data in a secure, anonymous and privacy protected manner. We have thereby taken due care that data cannot be traced back to individuals, while during the data analyses confidentiality was maintained by data coding.

The GDPs asked permission from patients with clinical assessed measures during consultation. In case of minors, permission was asked from the patient’s parents or legal guardian. The data for the clinical assessed measures were collected and anonymized before being analyzed by Achmea. So re-identification was precluded and written permission not required.

Claims records and clinical records were used with permission from Achmea and the dental practices. Consent of the participating GDPs was part of the contract between the dental practices and Achmea.

Consent for publication

Not applicable.

Competing interests

This study was funded by Achmea and the authors RH and OvdG are employees of Achmea. All authors declare no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart selection outcome measures. Flowchart of the identification and selection of the outcome measures, and overview of the tested measures and their sources
See this image and copyright information in PMC

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