Dental Informatics Programme Newsletter

July 2010

Dental Informatics Programme

Stephen Goold
Dental Informatics Programme Manager
Tel: 0131 275 6316
stephen.goold@nhs.net


Kate Harley
Head of Dental Informatics Programme
Tel: 0131 275 6359
kateharley@nhs.net


David Conway
Consultant in Dental Public Health
Tel: 0131 275 6164
david.conway@nhs.net


ISD Scotland
Gyle Square
1 South Gyle Crescent
Edinburgh
EH12 9EB

www.isdscotland.org/dental

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Introduction

You´re reading Newsletter no. 3 of the ISD Dental Informatics Programme (DIP). Staff in the Information Services Division (ISD) and other colleagues in NHS National Services Scotland (NSS) have been working on a variety of different projects since the publication of our last Newsletter at the end of 2009. This is the first of what will be quarterly updates from June 2010, and we hope you find it interesting and informative. Let us know what you think, or share your interests in dental informatics with Stephen Goold (stephen.goold@nhs.net) — we really want to hear from you.

Welcome to Kate

We’d like to extend a warm welcome to our new Head of Programme, Kate Harley (kateharley@nhs.net), who's been in post since mid-June. Kate's very much looking forward to working with everyone in Dental World (and may even pay you a visit).

The Big Chart

Figure 1 Proportion of P7 children in Scotland with no obvious decay experience in 2009

Bar chart showing Proportion of P7 children in Scotland with no obvious decay experince in 2009

Our Big Chart in this Newsletter comes from the National Dental Inspection Programme (NDIP) Report 2009 and shows the proportion of Primary 7 (P7) children in NHS boards who showed no signs of obvious decay experience in their permanent teeth. Across Scotland, 63.6% of P7 children fall into this category, with a range of 55.5% to 76.2% across the fourteen NHS boards.

These findings illustrate the extent to which some NHS boards have already achieved the 2010 target and how close others are to achieving it. The 2009 P7 result of 63.6% with no obvious decay experience is a benchmark figure against which future P7 Detailed Inspection results will be measured. It is not only an improvement over the 2007 P7 NDIP results, where the figure for Scotland was 59.1%, but it is also the first time that this figure for Scotland has exceeded the national target of 60% for P7 children.

For further information, see also NDIP 2009 (below).

New HEAT target

From now until 2014, ISD will be supporting NHS boards to achieve HEAT HEAT target H9 — at least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish (FV) per year by March 2014 — via comprehensive provision of data used to monitor progress.

ISD will shortly be providing NHS boards with baseline population and individual child-centred FV activity data down to the level of datazone for the period January to March 2010 for their trajectories and local planning purposes. The activity data will be extracted from Childsmile Practice and from the Health Informatics Centre (HIC) database for Childsmile School/Nursery each quarter from October 2010 via a multistage interrogation of the data sets in all settings for all children who receive fluoride varnishing and will then be supplied to our HEAT colleagues, enabling them to publish details of progress made against the target. That progress will be measured against the worst-performing SIMD quintile. The target should be met for each local SIMD quintile.

This high-profile work requires a substantial commitment on ISD's part over the next four years.

Dental Action Plan monitoring

ISD is in the process of submitting to NHS boards the latest 6-monthly report on their performance against key measures in the Action Plan for Improving Oral Health and Modernising NHS Dental Services.

Readers of this Newsletter will recall that the targets apply to oral health improvement (such as level of decay experience in children), dental workforce (e.g. achieving 1 dentist per 1,750 population), service provision (such as increasing the levels of people registered with an NHS dentist) and quality of services (e.g. the level of dental practices conforming to practice inspection criteria).

In October 2010, ISD intends to make the first publication of these 6-month reports under National Statistics; the report will refer to the period January to June (i.e. end of the school year) 2010.

Childsmile

Rachel Porteous (rachel.porteous@nhs.net), Dental Information Team analyst, describes the background to her recent involvement in the development of Childsmile practice profiles.

“As part of the Childsmile evaluation of outcomes related to the impact of dental services, and in collaboration with the Community Oral Health (COH) Section, University of Glasgow Dental School, I created profiles for all participating Childsmile dental practices located in the West of Scotland (Ayrshire & Arran, “old” Argyll & Clyde, “old” Greater Glasgow and Lanarkshire NHS boards) for each of the 16 quarters ending March 2006 to December 2009, i.e. over a four-year period. This important work will also involve collaboration with colleagues in the in Washington DC National Institute of Health - National Institute of Dental and Craniofacial Research (NIH-NIDCR), who have expertise in time-series analyses of large complex datasets.

The primary aim is to compare treatment activity and impact on GDS services as the Childsmile programme has been rolled out. Three separate final files for each of the quarters were created:

  • A patient file containing anonymised patient data for each dentist's personal numbers and dental practice location numbers. The data were aggregated by age group of patient, and the deprivation quintile associated with the postcode of the patient's home address was included. A flag was also included to indicate whether the patient was registered with a Childsmile practice or a non-Childsmile practice.
  • A dentist file containing such anonymised variables as dentist's personal and location numbers, age and sex, year of qualification, dentist's non-salaried or salaried status, employment as assistant or trainee, the deprivation quintile associated with the dental practice address, and the date on which the practice commenced offering Childsmile services, if at all.
  • A treatment file containing anonymised patient data including the type and number of courses of treatment received by patients, at each Childsmile or non-Childsmile practice. Data were aggregated by age group of patient, and again included the deprivation quintile associated with the postcode of the patient's home address.

I extracted the relevant data from MIDAS (Management Information & Dental Accounting System, the payment and information database of the GDS), then linked most of the data using SPSS. However, due to incomplete recording of patient CHI numbers in MIDAS, it was also necessary to run probability matches based on the patient's surname, forename, sex, date of birth and CHI, in order to link records for those patients receiving Childsmile services to those records for children registered with a GDS dentist. (Not all children receiving Childsmile services are registered with a GDS dentist, and vice versa, and of course many children receive Childsmile services at nursery or primary school).

To conclude our data capture, Lynn Brewster, former Childsmile Programme Manager in the West region, provided me with the dates on which each dental practice started participating in Childsmile; meanwhile, while Jamie Kidd, Database Officer at Glasgow Dental Hospital, supplied relevant data (sex, date of birth and CHI number) for each child receiving Childsmile services. At the end of each quarter, ISD continues to send Jamie a CHI'd extract that enables appropriate payments to be made to participating Childsmile practices for the work they carry out.”

In a future Dental Informatics Programme Newsletter, we'll explain how this valuable work is being put to good use.

Scottish Dental Practice Board (SDPB) Annual Report, 2009/10

Between April and September each year, ISD's Dental Information Team is heavily involved in providing key data, selected information and supporting narrative for the SDPB Annual Report. For the 2009/10 Report, a departure from previous years' Reports has been signalled, however, and interested readers should look out for a modernised, streamlined web-based publication with links to data and information housed on ISD web pages. The popular Executive Summary of the Annual Report will be retained, albeit with a more striking appearance and informative content for professionals and public alike. Planned publication date for both releases is 30 September 2010.

Annual digest of NHS dental statistics

As mentioned in the last Newsletter, to complement information contained in the SDPB Annual Report, ISD intends to publish an annual digest of dental statistics taking in data from the full range of oral health, NHS dental services - general, community and hospital - and dental health informatics. This digest will incorporate interpretation that will be of interest to a wide range of stakeholders in dentistry. ISD will be delighted to hear from you if you have a view on what could — or should — be included in this digest. Please send your ideas to Stephen Goold at (stephen.goold@nhs.net).

Dental data mart — progress report

Steven Williamson (steven.williamson@nhs.net) writes that ISD analysts are now using the conformed dental data mart for producing analysis, including information requests and National Statistics releases. CHI seeding is now part of the monthly load process, although the thresholds used to derive CHI may be reviewed in order to improve the “hit-rate”, as may our methods of dealing with records where there is no CHI derived. Another current development is our review of the structure of the dental mart and assessment of how it can be improved for use by analysts.

The project to add both NDIP and Childsmile information into the dental data mart has been completed in user-acceptance testing (UAT), i.e. all the processes are working as they should. The next stage is to move the data into the production environment and agree timescales; this will involve liaison with NHS boards, and data quality will feature heavily.

In addition to these developments, data by the analysis geographies Scottish Parliamentary Region and CHP of Residence are currently being tested through UAT before moving them into the production environment.

NHS dental registrations data

We have some important news for you on dental registrations: the information ISD Scotland publishes on NHS dental registrations is changing for several reasons, and these are explained below.

Implementation of government policy

Scottish Government policy has determined that from 1st April 2010, the registration period of all patients registered with an NHS dentist is non-time limited; this means all existing patients and all new patients are registered for life, and registration arrangements no longer lapse after a set period. Registration payments will be made at a reduced level (20%) to dentists whose patients have not attended for 3 years, i.e. those who would have lapsed under old arrangements. Dentists are still entitled to de-register any patients they no longer wish to treat under NHS arrangements. A registration arrangement will, however, come to an end, and continuing care or capitation payments cease, where Practitioner Services Division has determined that a patient has died, moved out of the country or registered with another dentist in the UK.

Changes in methodologies

The methodology ISD Scotland uses for analysing NHS dental registrations will change: analysis will no longer be based on the postcode of the dental practice where the patient is registered, but on the postcode of the registered patient. We need to make this enhancement because in some cases at present the natural "cross-boundary flow" of people living in one area but being registered with a dentist whose practice is based in another area is such that the number of people registered exceeds the actual population of that geographical area (and therefore the level exceeds 100%). Conversely, a geographical area where there are few or no dental practices may appear to have a much lower number (and therefore level) of people registered.

The fundamental changes proposed to the way registrations data are presented will result in more meaningful information being made routinely available to dentists, health service planners, public health specialists, and others involved in the provision of NHS dental health services.

Improvements in data quality

In preparation for the changes in methodologies, we appended the Community Health Index (CHI) number to the patient registration dataset and in so doing identified a proportion of patient records for which CHI number cannot currently be matched; without CHI number, the correct postcode of the patient cannot be added to the patient record, thereby creating a data deficit. The ISD Dental Team is actively working on ways to address this, and we’ll keep all stakeholders aware of the progress we make.

Further exercises undertaken with patient CHI number identified potential duplicate registration records which were created over time within MIDAS, the electronic system used to pay NHS general dentists, and which have caused over-reporting of registrations data. However, automatic and manual measures are now being tested in order to prevent such duplication from recurring.

Records of deceased patients, which have not been culled from the registration dataset, will be removed by means of new procedures for the next National Statistics release and all future releases.

Development of new analyses

ISD Scotland will introduce a “participation” measure to supplement registrations data. This will show the frequency with which people visit their NHS dentist over a one-year or two-year period and will provide indicative activity patterns of dentists across Scotland securing and maintaining dental health for their patients over what may be long and intensive courses of dental treatment (something that registrations data do not show reliably).

Registrations data will also be enhanced by the inclusion of analysis at a further level of geography, i.e. Scottish Index of Multiple Deprivation (SIMD) of patient residence. Data will continue to be presented at the levels of NHS board, community health partnership, local authority, Scottish parliamentary constituency and Scottish parliamentary region.

ISD Scotland intends to publish registrations data as close as possible to the date of their extraction, so that a more up-to-date picture can be provided. The timetable below sets out how and when the developments detailed above will be implemented over the coming year and what the effect will be on registrations data as presented by ISD Scotland under National Statistics.

Dental registrations data to be published under National Statistics by ISD Scotland, 2010/11

May 2010

Dental registrations data as at 31st December 2009

  • using current (i.e. old) methodology (based on dental practice postcode, and with records of deceased patients removed)

August 2010

Dental registrations data as at 31st March 2010 and as at 30th June 2010

  • using old methodology (based on dental practice postcode, and with records of deceased patients and duplicates removed)
  • using new methodology (based on patient postcode, and with records of deceased patients and duplicates removed)

November 2010

Dental registrations data as at 30th September 2010

  • using new methodology only
  • initial participation analysis
  • at SIMD level (in addition to current geographies)

February 2011

Dental registrations data as at 31st December 2011

  • using new methodology only
  • participation analysis
  • at SIMD level (in addition to current geographies)

NDIP 2009

On 8 June, Public Health Minister Shona Robison announced the findings of the 2009 National Dental Inspection Programme (NDIP) report at the 2010 NHS Scotland: the dental health of primary seven (P7) pupils in Scotland has reached the best level ever recorded. The proportion of children with no obvious decay experience is 63.6%. This exceeds the national target set by the Scottish Government, which states that at least 60% of P7 pupils should show no signs of obvious decay experience in their permanent (second) teeth by 2010.

The full report, which covers school year 2008/09, shows that ten of the fourteen NHS boards in Scotland now exceed the target, with four NHS boards only a few percentage points below this level. The survey focuses on P7 children and continues to show an improvement in the percentage of P7 children who show no signs of having decay, extractions or restorative treatment in their permanent teeth.

As the findings were announced, Graham Ball, Chairman of the Scottish Dental Epidemiological Coordinating Committee and Consultant in Dental Public Health for NHS Fife, said the results were extremely encouraging: “This is the third survey of P7 children since 2005 and it shows that dental health in this age group is steadily getting better. This is an improvement of over 10% since the 2005 survey of this age group when 52.9% of 11 year olds were found to have no obvious decay experience in their adult teeth. We now have the best level of dental health for P7 children in Scotland since records began.”

With ongoing dental initiatives in place throughout Scotland, this improving trend should continue, with the dental health of P7 children in Scotland benefiting still further.

“The results continue to identify a strong association between social deprivation and dental disease, with those in the least deprived areas having fewer teeth affected by dental decay than those in more deprived areas. However, it is particularly encouraging to see in this report that dental health has improved across all areas with larger gains being seen in areas where deprivation is at its greatest.”

Graham added: “Both local and national initiatives to improve dental health in children have been ongoing for several years and these results confirm the benefits of those investments. However, we must ensure that this work continues to be a priority in the long term if young people in Scotland today, and the adults of tomorrow, are to have better dental health than their forebears.”

The ISD Dental Team, together with Dr Alex McMahon of the Community Oral Health Section, University of Glasgow Dental School, is pleased to have been so closely involved in the collection, analysis and publication of NDIP report data since 2004; we look forward to playing an even bigger role in years to come, as ISD's role develops further into hosting, linkage and publication of NDIP data.

Meanwhile, Stephen Watson (stephenwatson@nhs.net), Dental Information Team analyst, updates us on further work the team has been undertaking on NDIP.

“Between March and June 2010, I´ve been working on a variety of different information requests relating to P1 Basic NDIP inspection data for 2009. The first of these requests involved matching the NDIP data from the most recent Scottish Index of Multiple Deprivation (SIMD) to the postcode of both the pupil and the school, which allowed for a comparative analysis of data at both NHS Board and Scotland quintile level. SIMD analysis at school postcode level was “new territory” and provided an interesting perspective on NDIP analyses.

Other NDIP analysis, requested by our Scottish Public Health Observatory (ScotPHO) colleagues, required all category C examinations at datazone, CHP and NHS Board level geographies (category C means the inspected child has no obvious decay experience, but should continue to see the family dentist on a regular basis). The data we provide will populate the child oral health section of the forthcoming CHP profiles report, scheduled for publication in November 2010".

Strategic objectives

As the Dental Informatics Programme moved into 2010/11, our Programme objectives have developed in their detail, but our key Strategic Objectives remain centred on four key areas:

  • Deliver Scottish Health Information Service (SHIS)—Dental (dental data warehouse and development of stakeholder access portal for Area and Special NHS Boards / SGHD / Practitioners) and linkage of key dental datasets.
  • Support delivery of Childsmile - the national oral health improvement programme - including children’s NHS dental service redesign.
  • Develop and enhance quality of dental health data across agreed datasets and via delivery of core dental information services: National Dental Inspection Programme, Scottish Health Survey dental module, Primary care data.
  • Develop and enhance quality of dental service data across agreed datasets and via delivery of core dental information services: the new HEAT target for dental services, workforce, training, quality, new Statement of Dental Remuneration, General Dental Service, Scottish Public Dental Service, Hospital Dental Service.

If you would like more information on how we are going about achieving these objectives, please contact Stephen Goold.

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