Title: Improving patient dental trauma injury management - development of a minimum dataset for consistent recording of treatment outcomes in traumatic dental injuries and planning implementation for wide NHS adoption. (OPTIMuM: improving Patient Trauma Injury treatment Management)
Funder: Department of Health and Social Care

Abstract: BACKGROUND Unmet health need: Traumatic dental injuries (TDI) are common and can occur across the life course. Prevalence in childhood has been reported at 20-30%7. Children with TDI experience negative social judgments/exclusion, bullying and teasing by their peers about their appearance8,9. PPIE contributors with lived experience of TDI have referred to the disfigurement and long-term impact of treatment and the concerns they have about treatment continuing throughout adulthood. Thus TDI, whilst not life threatening, cause's similar impacts to children's quality of life as those seen with cleft lip and palate and burns10,11. Data about treatment of TDI in the NHS is scarce, attributed to poor recording of clinical findings and treatment outcomes. Until we have robust data that can be used for audit and research, we cannot identify the true impact of treatment of TDI on the patient, their family nor can we drive NHS quality service improvement. AIM To improve treatment management for patients experiencing dental trauma injury and drive NHS quality care OBJECTIVES To create a minimum dataset for TDI that supports consistent recording of treatment outcomes To design the dataset to be meaningful for both patients and clinicians To plan an appropriate NHS implementation strategy following a feasibility testMETHODS The uptake of a minimum dataset in routine clinical practice is a complex intervention. In line with MRC guidance12, a theoretical framework, in this case, Normalisation Process Theory, will underpin this research. PRE-OPTMuM NIHR-DF: with the RCS Fellowship I am undertaking critical PhD research that underpins the NIHR-DF. This is to identify what outcomes are important to patients and their families following TDI treatment.The Doctoral Fellowship OPTIMuM project will be delivered in 3 further stages: OPTIMuM Stage-1 will identify what outcomes are important to NHS clinicians, using a two-stage Delphi survey. The minimum dataset for TDI (MD-TDI) will be finalised during a consensus meeting using Nominal Group Technique with key stakeholders, clinicians, PPI contributors, NHS managers and commissioners.OPTIMuM Stage-2 will comprise design and development of the MD-TDI working with software developers, clinicians and Patient and Public Involvement and Engagement contributors. The design will be informed by the principles of 'User Centred Design'.OPTIMuM Stage-3 will involve introduction of the MD-TDI to the clinical setting for 'real-life' feasibility test. The findings from this will inform the development of a robust implementation plan. TIMELINES FOR DELIVERY See GANTT chart for study timelines Pre-OPTIMuM Part time delivery with RCS Fellowship June 2018-Sept 2019 Stage-1: October 2019-March 2020 Stage-2: March 2020- June 2020 Stage-3: July 2020-September 2021 ANTICIPATED OUTPUT AND DISSEMINATION Video summaries (one for patients, one for professionals) for dissemination via social media and project website End of study report (including Plain English report) End of study event - patients, clinicians, management and commissioners OPTIMuM website Publication in scientific journalsIMPACT The collection of key outcomes, identified and then tested through robust complex intervention methodology, will lead to a step change in the management of children with significant traumatic dental injuries

Lay abstract: BACKGROUND Lots of children experience broken or knocked out teeth. These are called Traumatic Dental Injuries, or TDI for short. TDI cause pain and distress and require emergency treatment. Treatment can be complicated, as children and their teeth are growing all the time. Therefore some children need lots of treatment and it can take many years before their treatment is finished. Frequently treatment continues into adulthood.There are lots of different treatments available for TDI, depending on the injury. However we are not very good at predicting which treatments will work best. This is mostly because dentists aren't very good at recording treatment outcomes (i.e. recording what happens to their patients as a result of their treatment). Without these 'outcomes' we can't do good research to find out which treatments are best. This means we can't predict how much treating TDI costs the NHS.AIM We will work with children, their parents, dentists and other NHS colleagues to identify what TDI outcomes should be collected and recorded by NHS dentists. We will then work with dental teams to test how best to collect this information. In the longer term, this well help us understand which treatments work best. DESIGN & METHODS We are already doing research to find out what outcomes are important to children who have had TDI. The results from that work will be used in this project. This project will start by finding out what dentists think is important when treating TDI. We will ask dentists who work in different types of clinics (high street dentists and dentists who work in hospitals) to agree on what is important. We will use a type of survey called a Delphi. This will help the dentists who do the survey to come to an agreement about what is important. The next stage aims to create a final 'minimum dataset' for TDI. This will be the list of outcomes that everybody (dentists, children and parents) thinks are important for TDI and should be collected and recorded by dentists. Dentists, patients and parents/carers, NHS managers and NHS commissioners will be invited to a consensus meeting. This is a structured meeting designed to help everybody agree what should be included in a minimum data set. We will use a technique called Nominal Group Technique to help us do this. The final part of the project is to design how these outcomes should be recorded and plan how we ensure dentists will use the dataset.If we want dentists to use the minimum dataset, we need to make it easy to use. We also want to find out if children and their parents would like to record their own outcomes. If they would, we will ask them to help us design the software for them to use. Once we have designed the software we will test how it works. The test will take place in the Dental Hospital at Leeds over three months. PATIENT AND PUBLIC INVOLVEMENT (PPI) This project proposal was presented at the School of Dentistry Smile Aiders PPI forum. Members of the forum highlighted the importance of capturing the impact of trauma on self-esteem and quality of life. Two patients and their parents, with lived experience of dental trauma, have agreed to be on the study advisory committee. They will help with design of the research, participate in the consensus meeting and advise on dissemination.DISSEMINATION An End of Study report will be produced.Summary videos will be made - one for patients and one for dentists. The reports and videos will be made available on the project website.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: ORAL AND GASTROINTESTINAL