Title: Assessing and improving the quality of dental care for patients and the public.
Funder: Department of Health (England)

Abstract: Timeline: March 2013 – May 2014 The Programme Development Grant work plan has three Stages. Stage 1 (systematic review) In GP practice settings we have examined quality of care and developed the following definition: Access to effective care (clinical and interpersonal) from a learning organisation that leads to desired health outcomes (19, 27) and methods for developing and testing quality measures (9,13). An agreed definition of quality and quality measures are absent in dentistry. We shall conduct three studies: First, a systematic review (extent to determined by the timetable and cost confines of the PGD) to produce a list of quality indicators and measures. The second study will be a national preliminary survey identufy the key issues in the public consciousness with regard to quality and dental care. We will develop a first draft taxonomy; a set of dimensions of quality based on the international evidence base and literature. The third study will undertake exploratory analysis or finding datasets necessary to quantify the cost of dental service provision. During the Programme Grant this taxonomy will be refined in an iterative process based on the indicators and quality tools identified as the systematic literature reviews (PG: Study 1a) widen and deepen. Method : Literature review and online survey. Scope: all primary dental care provided to regularly attending patients, excluding patients with special care needs. Deliverable : Preliminary list of indicators and quality measures and an initial taxonomy and set of dimensions of quality of dental health care. PDG Study 1a Undertaking a systematic review to identify key attributes and components of quality primary dental health care: The aims of this review will be to identify and synthesise key attributes and components of quality primary dental health care so that we can develop a preliminary taxonomy, set of dimensions of quality of dental care and identify existing indicators, criteria and tools for assessing quality, based on the international evidence base and literature (academic and unpublished grey literature). The academic literature will be examined through a written search strategy and the grey literature via the world-wide-web, contacting key stakeholders, policy makers and professional societies in the UK and internationally. The extent of the review in the PDG will be dictated by the volume of the literature balanced with the costs and time constraints of the PDG. We aim to produce a simple list of indicators with a preliminary judgement of their quality. We will start from the basis of the work we have conducted in general practice and dentistry and recognise that some indicators will be at an individual level and some will be on a population level, either practice or geographical. We will fully involve a user researcher (NH) in the design, conduct and interpretation of outcomes of the review. Research, professional, policy and grey literature will be searched using systematic and comprehensive search strategies in appropriate databases and on the Internet. Searches will be undertaken on: 1. Electronic databases will be searched including MEDLINE, CINAHL, EMBASE, HSRProj etc.); 2. Material generated by user-led or voluntary sector enquiry will be identified via electronic databases for grey literature, internet search engines and websites for relevant NHS (including complaints databases) , UK government departments and charities e.g. British National Bibliography for Report Literature, GOOGLE Scholar. We will also search the web sites of dental regulatory bodies, professional associations, specialist societies in the UK and internationally. 3. Additional studies will be identified by scanning the bibliographies of recent reviews and newly retrieved articles, by brief targeted author searches and forward citation searching. Recently completed research projects will be contacted directly to enquire whether or not the research has been completed and if there are any subsequent publications. Search terms relating to the key concepts of the review will be identified via i) discussion between the research team and an information officer from University of Manchester John Rylands Library, ii) scanning the background literature and iii) browsing the MEDLINE thesaurus (MeSH). Subject specific searches will be augmented by methodological filters for study design. 4) In order to identify any dimensions of quality, indicators, criteria or tools not published in the literature, we shall complete a short on line questionnaire survey of international dental practice organisations, using contacts provided by the British Dental Association, International Association of Dental Research, the World Health Professions Alliance and the World Dental Federation (FDI). Review Strategy: Two reviewers will independently screen titles and abstracts for relevance, using the defined inclusion criteria. Where both reviewers agree on inclusion, or where there is disagreement, the full text article will be retrieved. The two reviewers will independently assess the full text of the articles against inclusion criteria. Any remaining disagreements will be resolved through discussion with other members of the team. Data Management & Extraction: All potentially eligible records will be imported into a bibliographic referencing software program (EndNote version XI) and duplicate references will be identified and deleted. Data extraction and validity assessment will be performed by one reviewer and independently verified by a second. Discrepancies will be resolved by referral to the original studies, and if necessary, through arbitration by a third reviewer. Data extraction will be guided by a pre-specified data extraction sheet detailing key features of the study sample, setting, methods, intervention, control (if appropriate), results and conclusions. Studies will be assessed for methodological quality across all phases of the review. Quality assessment: All eligible studies will be included and a judgement will be made of their quality depending on the volume of the literature and the time and resources available in the PDG. PDG Study 1b Undertaking a national online survey of public opinion to explore the attitudes of a nationally representative sample of the public on quality in dentistry. This survey will be undertaken in association with IPSOS MORI (37) We plan to complete 500 (95%CI, se=2.55, with 50% response rate minimum required N=385) face-to-face interviews with adults in England. A mix of closed and open-ended questions will be asked and will include questions on: Identify key dimensions of quality for health services in general Impressions of quality of dental care provided by the NHS and private sector Identify key dimensions of quality in dentistry Responses will be coded and simple fequency distributions/content analysis will be undertaken. Responses from the public will help us identify gaps in the list of quality indicators unearthed in the systematic review and dimensions of quality that need to be included in our developing taxonomy. Study 1c We will use the PDG phase to do some exploratory analysis of datasets necessary to quantify the cost of dental service provision. For quality incentives to be cost-effective, the price paid by commissioners\policy makers needs to be set somewhere between the maximum amount they are willing to pay for the outcomes associated with the expected improvements and the provider's (dentist's) costs of producing these improvements i.e. the price level should provide value for money for the commissioner in terms of the additional quality produced for the investment and enough profit for the provider to make quality improvement attractive. This ‘gainsharing’ approach has not been implemented in financial incentive schemes and will be the prime focus of the health economic component of the PG. Stage 2: Team Strengthening, Research Capacity Development and User involvement We have already assembled a multi disciplinary team with the necessary skills, influence, experience and successful track record of delivery to complete the programme to a very high standard. We want to strengthen the team to support effective national and international dissemination, to build research capacity and to establish structures and relationships to realise our vision of the UK being a global leader in research quality. As the programme development stages and studies are delivered it is likely that the make up of the research team will change according to the programme’s evolving needs and other academic, clinical, managerial and user representative co-applicants could be included on the main programme grant application. Stage 2 will enable the project team to meet regularly during the project in order to finalise the key aspects of the Programme Grant. It will combine elements of relationship and team building, with a particular focus on enabling the service users to integrate into and become familiar and comfortable with the whole project team. As part of this process we will provide universal research teaching to ensure all members of the team have the same baseline knowledge and provide support and research training for patients and members of the public who wish to develop to the level of user researchers. In this stage we will develop close working relationships with dental system suppliers companies, information suppliers to the NHS commissioning board and seek partners for developing innovative methods of data collection for patient rated outcome and experience measures. We will also develop our working relationship with TRUSTECH to protect IP and exploit the commercial opportunities emerging from the research programme. We will work with Inspiration North West and RS and JA to recruit a representative panel of service users to provide an independent oversight of the research programme and advise the team at each stage of the programme. This Programme Steering Group will support the strategic management needs and research governance needs of the programme. The Programme Steering Group will include the CEO of the Patients Association, the Department of Health policy lead on quality, dental academics and clinicians and GDC and BDA representatives - but users will be in the majority. As part of our communication strategy we will design and develop a website and establish an International Dental Quality Liaison Group to develop our international leadership in this field. Stage 3: Preparation and finalisation of Programme Grant We will focus on synthesising the findings from PDG studies 1a, 1b, 1c into the full Programme Grant proposal, finalising the team and develop a consensus about the content and design of the full programme grant.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: ORAL AND GASTROINTESTINAL