Members of the Initiative to Integrate Oral Health and Medicine, including Jane Barrow, MS, associate dean for Global and Community Health and executive director of the Initiative to Integrate Oral Health and Medicine at Harvard School of Dental Medicine (HSDM), recently collaborated with the FDI World Dental Federation and the International Consortium for Health Outcome Metrics (ICHOM) to develop a baseline standardized set of patient-centered outcomes for adult oral health. Hawazin Elani, PhD, assistant professor of Restorative Dentistry and Biomaterials Sciences at HSDM, and Lisa Simon, DMD, MD, consulted during the planning phase. Titled, "Developing a standard set of patient‐centred outcomes for adult oral health – an international, cross‐disciplinary consensus," the article was published in July of 2020. Creating a data-driven minimum Adult Oral Health Standard Set (AOHSS) for use in clinical practice, research, advocacy and population health will ultimately help patients and providers make more collaborative and informed decisions about treatment and care.
“We were delighted to participate in this international, collaborative working group. Our work at the Initiative to Integrate Oral Health and Medicine strives to understand the value of oral health care and how it impacts health and cost outcomes related to overall health and wellness,” said Jane Barrow. “Developing a tool kit that contributes to the promotion of value-based care is a perfect fit with our mission.”
According to Barrow, the aim of the standard set is to balance a comprehensive set of measurements across the life course for common and preventable oral health conditions with feasible recommendations that providers can reliably implement. The group’s task was to deliver a minimum oral health standard set which will enable outcomes measurement in routine clinical practice to improve clinical decision-making between providers and patients, facilitate quality improvement, and allow for benchmarking across organizations. “These metrics are an integral component of value-based care,” added Barrow.
Stefan Listl, MD, PhD, a professor in Quality and Safety of Oral Health Care at Radboud University in the Netherlands and head of Translational Health Economics at Heidelberg University Hospital in Germany, is one of many collaborators on this project. He emphasizes how valuable this data set will be for providers and patients across the globe. “For many years, the abundance and heterogeneity of oral health measures has been a major roadblock for facilitating meaningful reflections and evidence-based decision making toward improving people's oral health. A short set of internationally consented oral health measures can be a game changer for operationalizing feedback information such that it can have a meaningful impact on oral health,” he said.
This collaboration involved experts from different professions, time-zones, and industries, as well as service users who brought the patient perspective to the work. Deborah Cole, BDS, MBA, FAICD, GAIST, chair of Australian Centre Value Based Health Care and CEO of Dental Health Services Victoria, shared why this project benefited from bringing so many people to the table. “This was a collaborative effort from people from all parts of the profession with different goals. That meant that discussions were robust as the individuals could easily identify if the set being developed was practical for how they envisaged using it,” Cole said. “The set is better due to those robust discussions.”
While other studies of population oral health exist, this collaboration is the first of its kind on such a large scale. “One of the challenges in reviewing much of the research on population oral health is the lack of a consistent approach in both methodology and the data which is collected. The result is that it is difficult to compare one study with another.” said David Williams, BDS, MSc, PhD, FRCPath, FDS RCS. Dr. Williams is the professor of Global Oral Health and the lead for the Centre for Dental Public Health and Primary Care at Bart's and The London School of Medicine and Dentistry, Queen Mary, University of London. He added. “From a routine care standpoint, we have created a data set that reflects what patients expect. From a research standpoint, we now have a common approach to measuring oral health that can be used in a range of different settings where everyone is using the same platform to collect data. This will allow comparisons to be made across settings and studies, leading to greater research efficiency.”
One of the priorities of developing a standardized set of outcomes was to give patients an opportunity to play a more significant role in their own care. “The set of outcomes that we’ve developed respects the views of the patient,” said Williams. “It means that you as a patient are not just a receiver of care, but a contributor to your own health outcomes. Your oral health is an important part of your overall health and sense of well-being. Now, with this data set, you as a patient have the kind of language that enables you to communicate your problems and expectations with the person providing your care.”
Cole has already implemented this new model at Dental Health Services Victoria. “We have totally redesigned the patient journey – with patients and clinicians. We have restructured a team that delivers the care so that the right service is provided to the right patient at the right time and in the right place by the right caregiver,” she said. “Outcomes are needed at all steps of the patient journey to help treatment plan, undertake shared decision making, measure progress and review.”
The long-term impact of developing baselines and indicators to measure oral health outcomes could substantially change the way that care is delivered and measured across populations. Listl outlines just a few ways that this study could influence oral health outcomes. “The potential impact is vast and includes reflective learning by dental care teams based on feedback information about patient outcomes, medical-dental integration through early detection of oral conditions in medical settings, value-based payments which link reimbursement to oral health outcomes, epidemiological monitoring and cross-country comparisons of dental care systems performance, and needs-based planning for the oral health workforce which is essential to ensure safe, efficient, and sustainable oral health care.”
Andria Joseph, a project manager for ICHOM, acknowledges what an exciting opportunity this study presents for providers all over the world. “ICHOM is delighted that the manuscript detailing the creation and development of the standard set has been published by the International Dental Journal. We hope that this will provide a greater understanding of the Adult Oral Health (ORA) Standard Set, and that it will be a valuable material to be used alongside other resources,” she said.
The collaboration between the FDI World Dental Federation, ICHOM, and the many professionals who’ve contributed to this study, lays a strong foundation for population oral health outcomes in the future. “I believe this is the start of a journey,” said Cole. “If we all look toward providing value in all of the settings that interventions are provided, it will be necessary to have a small number of simple health outcome indicators that are easy for patients to understand so that they can be involved in the shared decision-making process at the individual level, or supporting interventions at a community and population level.”
