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An International Working Definition for Quality of Oral Healthcare.

ABSTRACT: To assess and improve the quality of oral healthcare, we must first agree on what constitutes good care. Currently there is no internationally accepted definition for quality of oral healthcare. Therefore, the purpose of the study was to establish a working definition for quality of oral healthcare that would help to advance further improvements in the field of quality improvement in oral healthcare. The development of the working definition included a 3-step approach: 1) literature screening; 2) expert-based compilation of an initial list of topics, leaning on the National Academy of Medicine framework for quality of care; and 3) a World Café with voting, which took place during the annual general meeting of the International Association for Dental Research in 2018. Following this approach, the collective intelligence of involved participants yielded a comprehensive list of items, prioritized by relevance. The resulting working definition comprises 7 domains—patient safety, effectiveness, efficiency, patient-centeredness, equitability, timeliness, access to care—and 30 items, which together characterize quality of oral healthcare. This aspirational working definition provides the potential to facilitate further conversations and activities aiming at quality improvement in oral healthcare. KNOWLEDGE TRANSFER STATEMENT:This special communication describes the development of a working definition for quality of oral healthcare. The findings of this study are intended to raise awareness of the relevance of quality improvement initiatives in oral healthcare. The working definition described here has the potential to facilitate further conversations and activities aiming at quality improvement in oral healthcare.

SUBMITTER: Righolt AJ

PROVIDER: S-EPMC7079288 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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An International Working Definition for Quality of Oral Healthcare.

Righolt A J AJ Walji M F MF Feine J S JS Williams D M DM Kalenderian E E Listl S S

JDR clinical and translational research 20190918 2

To assess and improve the quality of oral healthcare, we must first agree on what constitutes good care. Currently there is no internationally accepted definition for quality of oral healthcare. Therefore, the purpose of the study was to establish a working definition for quality of oral healthcare that would help to advance further improvements in the field of quality improvement in oral healthcare. The development of the working definition included a 3-step approach: 1) literature screening; 2 ...[more]

PMID: 31533017

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Project description:BackgroundImproving facility-based quality for maternal and neonatal care is the key to reducing morbidity and mortality rates in low- and middle-income countries. Recent guidance from WHO and others has produced a large number of indicators to choose from to track quality.ObjectiveTo explore how to translate complex global maternal and neonatal health standards into actionable application at the facility level.MethodsWe applied a two-step process as an example of how the 352 indicators in WHO's 2016 Standards for Improving Quality of Maternal and Newborn Care in Health Facilities might be reduced to only those with the strongest evidence base, associated with outcomes, and actionable by facility managers. We applied Hill criteria and assessed whether indicators were within the control of facility managers. We next conducted a rapid review of supporting literature and applied GRADE analysis, retaining those with scores of 'moderate' or 'high'. To understand the utility and barriers to measuring this limited set of indicators in practice, we undertook a case study of hypothetical measurement application in two districts in Bangladesh, interviewing 25 clinicians, managers, and other stakeholders.ResultsFrom the initial 352 indicators, 56 were retained. The 56 indicators were used as a base for interviews. Respondents emphasized the practical challenges to the use of complex guides and the need for parsimonious and actionable sets of quality indicators.ConclusionsThis work offers one way to move towards a reduced quality indicator set, beginning from current WHO guidance. Despite study limitations, this work provides evidence of the need for reduced and evidence-based sets of quality indicators if guides are to be used to improve quality in practice. We hope that future research will build on and refine our efforts. Measuring quality effectively so that evidence guides and improves practice is the first step to assuring safe maternal and neonatal care.

Project description:ObjectiveTo evaluate effect of dental caries experience and untreated dental decay on Oral Health-Related Quality of Life (OHRQoL) in working adults.MethodsThe clinical records of 160 patients were reviewed. Dental health indicators were derived from individual tooth- and surface-level data allowing for calculating the number of decayed surfaces (D), number of decayed missed filled surfaces (DMFS), and significant caries (SiC) indices. A questionnaire was administered to verify demographic factors and OHRQoL. The questionnaire was administered via face-to-face interview, for patients in the hospital; or via telephone interview, for those who could not complete it during their hospital visit. Models were developed using multivariable linear regression to predict total OHIP-14 scores and examine the simultaneous association of independent and outcome variables. The model was adjusted for age, gender, and nationality..ResultsPhysical limitation and psychological discomfort were the most frequent impacted domains, affecting 17.1% and 7.5% of subjects, respectively. Painful aching was the most frequent item to have any impact, affecting 64.4% of the subjects. The results of multivariable analysis indicated that the SiC score could statistically significantly predict the Oral Health Impact Profile (OHIP) score, P=0.0003. In the linear regression model, for participants with DMFS equal to or higher than the SiC, on average, OHIP scores were almost 10 points higher than for participants with DMFS below the SiC.ConclusionThe more the dental decay the higher the impact on OHRQoL. From a dental public health perspective, using OHRQoL as a need assessment tool, along with dental clinical indicator, can be helpful in planning and targeting public health programs for the most in-need adult populations.Clinical significanceThis study identified that patients with severe dental caries report poorer OHRQoL. Clinicians should be aware of impacts that dental decay may have on OHRQoL, including physical, psychological concerns, and pain.

Project description:BackgroundLow anterior resection syndrome is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The low anterior resection syndrome score was designed as a simple tool for clinical evaluation of low anterior resection syndrome. Although the low anterior resection syndrome score has good clinical utility, it may not capture all important aspects that patients may experience.ObjectiveThe aim of this collaboration was to develop an international consensus definition of low anterior resection syndrome that encompasses all aspects of the condition and is informed by all stakeholders.DesignThis international patient-provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting.ParticipantsThree expert groups participated: patients, surgeons, and other health professionals from 5 regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in 3 languages (English, Spanish, and Danish).Main outcome measureThe primary outcome measured was the priorities for the definition of low anterior resection syndrome.ResultsThree hundred twenty-five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96%, and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to 8 symptoms and 8 consequences that capture essential aspects of the syndrome.LimitationsSampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this.ConclusionsThis is the first definition of low anterior resection syndrome developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of low anterior resection syndrome. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in low anterior resection syndrome over time and with intervention.

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An International Working Definition for Quality of Oral Healthcare.

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An International Working Definition for Quality of Oral Healthcare.

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