PROM Seminar Stockholm,
September 2014
Inger von Bültzingslöwen
Deputy Registry Manager/Senior Dental Consultant
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The Swedish
Quality Registry
for
caries and periodontal disease
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OVERALL AIM of SKaPa
– to promote high quality of care, patient safety
and good oral health
SPECIFIC AIMS
• Follow up treatments and results in clinics and on a
regional/national level
• Compliance with national guidelines
• Stimulate registry based research
• Enable patient reported evaluations
PROM SEMINAR STOCKHOLM 2014
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OVERALL AIM of SKaPa
– to promote high quality of care, patient safety
and good oral health
SPECIFIC AIMS
• Follow up treatments and results in clinics & regional/national
level
• Compliance with national guidelines
• Stimulate registry based research
• Enable patient reported evaluations
FORM THE BASIS TO
promote quality development in dental care
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The STRUCTURE of SKaPa
Information is reported to SKaPa,
not by dental health care personnel manually entering data
on a web site,
but data are being transferred via secured electronic files
(automatic feed)
from the dental health services electronic patient records to
the quality registry database
PROM SEMINAR STOCKHOLM 2014
The SKaPa main processes
Care procedures
Quality
development
Documentation in
the operating room
Electronic
patient
data
record
Reports
Analyzes
Automated
extraction/transfer
of information
Loading & storage in SKaPa relational data base
Public dental health care
Private dental health care
Grundkarta: SCB
Grundkarta: SCB
SKaPa now includes information about dental care
concerning 2,1 million adults and 1,0 million children
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OVERALL AIM of SKaPa
– to promote high quality of care, patient safety
and good oral health
SPECIFIC AIMS
• Enable follow-ups on
• treatments and results in clinics & regional/national level
• Follow-up on compliance with national guidelines
• Stimulate registry based research
• Enable patient reported evaluations (PROM/PREM)
WHICH WILL FORM THE BASIS TO
promote quality development
PROM SEMINAR STOCKHOLM 2014
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OVERALL AIM of SKaPa
– to promote high quality of care, patient safety
and good oral health
SPECIFIC AIMS
• Enable follow-ups on
• treatments and results in clinics & regional/national level
• Follow-up on compliance with national guidelines
• Stimulate registry based research
• Enable patient reported evaluations (PROM/PREM)
WHICH WILL FORM THE BASIS TO
promote quality development
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Methods
What have we done?
I. Defined patient populations
II. Constructed a questionnaire
III. Distributed the questionnaire by regular mail - pilot studies
IV. Analyses and conclusions.
National reference group with 8 skilled researchers/practitioners
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I. Defined patient populations
• low risk/healthy
• patients with caries
• patients with periodontal disease
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II. Constructed the questionnaire
Two global questions1,2:
HOW CONTENT ARE YOU WITH YOUR MOUTH AND TEETH?
HOW WOULD YOU DESCRIBE YOUR ORAL HEALTH?
1. Does different wording of a global oral health question provide
different results? Ekbäck G, Ordell S. Acta Odontol Scand. 2013
2. Pattussi MP, Olinto MT, Hardy R, Sheiham A. Clinical, social and
psychosocial factors associated with self-rated oral health in
Brazilian adolescents. Community Dent Oral Epidemiol.
2007;35(5):377-86
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Two questions on patients’ awareness of disease:
DO YOU CONSIDER YOURSELF HAVING PROBLEMS WITH
CARIES?
DO YOU CONSIDER YOURSELF HAVING PROBLEMS
PERIODONTAL DISEASE?
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Disease specific questions, anticipated to be of
specific importance for these patient groups:
inspired by
- works on oral health related QoL1, defining four aspects:
Function (chewing, swallowing; speech)
Social aspects (social interactions)
Pain (acute; chronic)
Psycosocial aspects (appearance; self esteeme)
- validated scales e.g the Oral Health Impact Profile (OHIP)2
1
Inglehart MR, Bagramian RA. Oral health-related quality of life: An
introduction I: oral health-related quality of life. Chicago: Quintessence 2002
2 Locker D, Jokovic A, Clarke M. Assessing the responsiveness of measures
of oral health-related quality of life. Community Dent Oral Epidemiol.
2004;32:10-8
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TO WHAT EXTENT HAVE YOU EXPERIENCED PROBLEMS WITH THE
FOLLOWING ISSUES, BEFORE AND AFTER THE LATEST TREATMENT
SESSIONS
NOT AT ALL; A LITTLE; MODERATE; BIG; VERY BIG
CHEWING
BEFORE TREATMENT
AFTER TREATMENT
TASTE
SPEECH
CLEANING TEETH
ORAL PAIN
TEETH APPEARANCE
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PREM
HAVE YOU FELT AS INCLUDED IN DECISION MAKING AS YOU
WANTED, REGARDING YOUR DENTAL TREATMENTS?
HAVE YOU RECEIVED INFORMATION FROM THE DENTAL TEAM
ABOUT WHAT YOU CAN DO TO STAY HEALTHY?
DO YOU THINK YOU WILL BE ABLE TO STAY HEALTHY?
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Frågor om din upplevelse av din munhälsa
Mycket nöjd
Nöjd
Varken nöjd
eller missnöjd
Missnöjd
Mycket
missnöjd
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Mycket bra
Bra
Varken bra
eller dåligt
Dåligt
Mycket dåligt
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Hur nöjd är du med din mun och dina tänder?
Hur skulle du beskriva din munhälsa?
Inga
Små
Måttliga
Stora
Mycket stora
Anser du dig ha problem med karies
(hål i tänderna)?
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Anser du dig ha problem med parodontit
(tandlossning)?
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I vilken omfattning har du upplevt problem före och efter din senaste behandlingsomgång
(kan innefatta flera besök) med följande:
Inga
Små
Måttliga
Stora
Mycket stora
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Att tugga maten?
- Före behandling
- Efter behandling
Att njuta av smaken på mat?
- Före behandling
- Efter behandling
Att tala och uttala ord tydligt?
- Före behandling
- Efter behandling
Att rengöra mun och tänder?
- Före behandling
- Efter behandling
Isningar eller smärta?
- Före behandling
- Efter behandling
Tändernas utseende?
- Före behandling
- Efter behandling
Frågor om dina upplevelser av delaktighet, bemötande och information
Ja
Delvis
Nej
Har du känt dig så delaktig som du önskar i besluten
om din tandvårdsbehandling?
☐
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Har du i samband med tandvårdsbesöken fått kunskaper om vad du
kan göra för att hålla dig frisk i munnen?
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Tror du att du kommer att kunna hålla dig frisk i munnen
i framtiden?
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PROM SEMINAR STOCKHOLM 2014
III- Distributed the questionnaire by regular
mail - pilot studies
1 800 individuals (3 x 600)
Answers
43.9 %
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IV- Results, analyses
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Percentage of respondants who were content or
very content with their mouth and teeth
healthy
caries
periodontitis
Percentage of respondants who considered
themselves having good or very good oral health
healthy
caries
periodontitis
No problems with caries
healthy
caries
periodontitis
No problems with periodontitis
healthy
caries
periodontitis
Difference in cheewing ability before/after treatment
healthy
caries
periodontitis
Difference in sensitive teeth before/after treatment
healthy
caries
periodontitis
Felt as included in desiscion making as they wanted
regarding dental treatments
healthy
caries
periodontitis
Had received information from the dental team how
to stay healthy
healthy
caries
periodontitis
Thought they would be able to stay healthy in the
future
healthy
caries
periodontitis
Considerations
Diiferences between groups are most obvious in the global
questions
Low number of respondants in the young and old age groups
Can the questions for patient reported evaluations
(PROM/PREM) form the basis to promote quality
development, patient safety and good oral health?
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How do we go on?
I.
Are patient populations adequate?
II. Revising the questions?
III. How do we distribute the questionnaire?
IV. How can we use the results to promote quality
development?
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SKaPa main processes
Care procedures
Quality
development
Documentation in
the operating room
Electronic
patient
data
record
Reports
Analyzes
Automated
extraction/transfer
of information
Loading & storage in SKaPa relational data base
The reference group
Anne-Christine Bolle
Inger von Bültzingslöwen
Monica Degerman Svensson
Gunnar Ekbäck who has analysed the data
Håkan Flink
Kaja Henning Abrahamsson
Catharina Hägglin
Elisabeth Wärnberg Gerdin
Sigvard Åkerman
Thank you!
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