Oral health quality indicators

HCQI Health promotion, prevention and primary care Sub Group

9th May 2012

Anne Nordblad

Ministry of Social Affairs and Health

Department of Social and Health Services

Finland

Background to the proposal

• Submitted on behalf of the The Working Group on Nordic Quality Indicators on Oral Health and Oral Health Care by Dr Mika Gissler on October 6 2011. The proposal is as follows

‘’The Working Group proposes that OECD initiate a project to develop

quality indicators for oral health and oral health care, as a part of the work

on quality indicators in primary health care’’.

The proposal builds on:

• The report: A Nordic project of quality indicators for oral health care 2010 (The Working Group on Nordic Quality Indicators on Oral Health and Oral Health Care) http://www.thl.fi/thl-client/pdfs/a389b3ed-a262-44c5-bad0-b9d3eecdf089

• EU-funded European Global Oral Health Indicators Development Project (EGOHID) project (2002-2008) (40 indicators) www.egohid.eu and

• The framework developed by the OECD Health Care Quality Indicators project.

Background to the proposal

Relevance: health, well being,the economy

• Poor oral health can affect a persons’ ability to eat properly and a poor diet can cause rapid deterioration in physical and psycho-social health

• Some evidence to suggest that poor oral health is a risk factor for cardiovascular disease and other life threatening conditions

• Between 60-90% of school children worldwide have dental cavities and between 5-20% of middle-aged adults have severe gum disease(WHO)

• Poor oral health can be particularly damaging to the elderly

• The economic costs of curative dental care are high, representing between 5 to 10% of total public health expenditure (WHO)

Relevance: inequality

0 5 10 15 20 25

% people by income quintile who felt they needed dental health care treatment but did not receive it

High Middle Low

Income Income Income

People in lowest income quintile

consistently more likely to

express higher levels of unmet

need

Portugal

Spain

Iceland

Sweden

Italy

Poland

Norway

France

Greece

Switzerland

Finland

Hungary

Estonia

Denmark

United Kingdom

Czech Republic

Germany

Austria

Slovak Republic

Ireland

Luxembourg

Netherlands

Belgium

Slovenia

Source: EU-SILC.

Relevance: access

Large variations in annual

consultation rates

0.1

0.3

0.6

0.7

0.7

0.8

0.8

0.9

0.9

1.0

1.2

1.2

1.3

1.3

1.4

1.4

1.4

1.5

1.6

1.6

1.7

1.8

2.1

2.1

2.3

3.2

0 0.5 1 1.5 2 2.5 3 3.5

Mexico

Turkey

Luxembourg

Chile

United Kingdom

Hungary

Poland

Denmark

Italy

United States

Austria

Switzerland

Finland

OECD

Australia

Estonia

Germany

Slovak Republic

Korea

Spain

France

Czech Republic

Belgium

Netherlands

Israel

Japan

Annual consultations per capita

Information on data for Israel: http://dx.doi.org/10.1787/888932315602

Source: OECD Health Data 2011.

Conceptual framework for indicator groupings:

1. Structure indicators

2. Process indicators

3. Outcome indicators

4. Potential quality indicators; (to be developed)

Defining and classifying clinical indicators for quality improvement.

Mainz Jan. International Journal for Quality in Health Care 2003; 15(6): 523-530.

Nordic Working Group indicators

STRUCTURE INDICATORS

INDICATOR GROUP / INDICATOR IMPORTANCE/RELEVANCE

1. Number of inhabitants per legitimate (licensed)

oral health care personnel under retirement age

The structure of health care systems is a key element in the

attainment of health goals, health care responsiveness and

equity.

NOTE

(variants of these indicators are collected via OECD Health

Data)

2. Number of inhabitants per active (licensed) oral

health care personnel under retirement age NOTE

(variants of this indicator are collected via OECD Health Data)

3. Number of licensed dentists under retirement

age per legitimate oral health care personnel

4. Oral health service expenditure per capita

This indicator can be used in comparative analysis of health

systems and can be used in conjunction with quality

measures to assess whether or not differences in

expenditure are systematically associated with changes in

quality.

Number of inhabitants/ licensed dentists

under retirement age

Nordic Working Group indicators PROCESS INDICATORS

INDICATOR GROUP / INDICATOR IMPORTANCE/RELEVANCE

5. Proportion of the population* who

used oral health services within a

year

*divided according to:

- The proportion of population under 18/19/20

years old

- The proportion of adults aged 18/19/20

years-old

NOTE

(variant of this indicator is collected via OECD Health

Data)

Describes the visiting pattern of oral health care

services – while is little evidence to support or

refute any particular frequency of dental check

visits, most public health authorities recommend at

least one annual visit to a dentist.

6. Oral health behaviour in school-

aged children:

a) Frequency of daily tooth brushing

b) Rate of consumption of non-diet soft

drinks

The two main dental diseases – caries and

periodontal disease can be effectively prevented

by good oral hygiene and by restricting the

frequency and amount of sugar consumption.

Consumption of soft drinks and other sugary food

stuffs has been associated with elevated risk of

poor oral health in adolescence, particularly caries

and dental erosion

Nordic Working Group indicators

OUTCOME INDICATORS

INDICATOR GROUP / INDICATOR IMPORTANCE/RELEVANCE

7. Proportion of caries free (no dentine

caries) in children and adolescents

Information about caries free children and adolescents is a good basis for

planning and for comparing the development of oral health status. This

indicator is commonly used to assess overall levels of oral health and to

monitor trends in oral health over time.

8. Dental caries severity (mean DMFT) in

children and adolescents (DMFT = Disease, missing, filled teeth)

NOTE

(variant of this indicators is collected via OECD Health Data)

Decay experience at early and / or later stages of severity assessed by

variations of the severity of caries index is accepted globally as a

standardised measure of one of the most common oral diseases.

9. Significant caries index (children aged 12

– based on WHO goal)

(mean DMFT of the one third of a population with the highest

caries values)

The distribution of caries prevalence as measured by the mean DMFT

indicator is typically skewed with a proportion of children having high or

very high DMFT values. Mean DMFT values do not accurately reflect this

and can result in misleading assessments indicating for example, that the

caries profile overall for a population is controlled.

The SiC indicator draws attention to the scale of severe dental caries in a

proportion of the population that has the worst dental caries index overall.

9. Edentulous (without teeth) prevalence in

adults aged 65-74

Loss of all natural teeth can contribute to psychological, social and

physical impairment. Edentulous prevalence is a measure of past disease

and an indicator of overall oral health.

10. Functional occlusion prevalence in adults

aged 65-74

People with impaired dentitions due to missing teeth often choose foods

that do not provide optimal nutrition – in the elderly, poor oral health can

lead to significant weight loss and a loss in well being more broadly.

Early tooth loss has also been shown to be a predictor of eventual

edentulism.

Proportion of caries free 12 year olds, %

Health status: 1.Caries free children and adolescents 2. Dental caries severity (mean DMFT) in children and adolescents 3. Significant Caries Index (SiC Index) 4. Edentulous prevalence in adults aged 65-74 years 5. Functional occlusion prevalence in adults aged 65-74 years

Non-medical determinants of health 1.Soft drinks consumption 2.Tooth brushing more than once a day

Health care system performance: Quality, access, cost/expenditure 1.The total cost per capita on oral health care 2.The proportion of population who used oral health services within the past year

Health care resources and activities 1. Number of inhabitants per legitimate oral health care personnel under

retirement age

2. Number of inhabitants per working oral health care personnel

3. Number of oral health care personnel per dentists under retirement age

Adapted from Conceptual framework for the OECD Health Care Quality Indicators Project

Potential indicators according to the Nordic

project

• Dental Contact within the past two years

• Self assessed oral health status

• Oral disadvantage due to functional limitations

Nordic project: Conclusions and recommendations

Quality indicators for monitoring

– access to care,

– periodontal diseases and their effective treatment,

– coverage of orthodontic treatment,

– success of root treatments

– the prevalence of erosion

were considered important by the working group and these fields need to be developed

The Subgroup is invited to:

–COMMENT on the feasibility of developing oral health and oral health care indicators (Given the balance of ongoing and new HCQI work is oral health care quality a priority area? Is the current information infrastructure conducive to their development? What data quality problems are envisaged?)