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Denplan

Creating and maintaining success through innovationHenry Clover BDS, Deputy Chief Dental Officer2Driving oral health innovation in the private sectorNHS AHSN ConferenceOctober 2015AgendaDenplan in context

The Denplan Excel Quality programme

Oral Health Score (c)

Denplan Excel Previser Patient Risk Assessment (DEPPA)Denplan in context?

Denplan a mixed health economy provider80% of Denplan members have an NHS commitment

Where UDAs are not delivered they revert back to the LAT to re-commission

Collect 42,000,000 per month to provide access to quality private dental careAgendaDenplan in context

The Denplan Excel Quality programme

Oral Health Score (c)

Denplan Excel Previser Patient Risk Assessment (DEPPA)The Denplan Excel Quality Accreditation programmeUniting requirements of both dentists and patients

The founding truths of Excel Quality programme - PatientsPatients are generally only aware of their oral health status at extreme ends of a spectrum

The founding truths of Excel Quality programme - PatientsPatients are generally only aware of their oral health status at extreme ends of a spectrum

In order to engage with patients to motivate them to make changes they require an understanding of their oral health status in a simple format

Change follows engagement and explanationTheres nothing that can be done in the surgery that cant be un-done by the patient before their next visit

Increasing range of regulations and professional/clinical requirements have to be taken into account

Risk assessment is key to determining future treatment needsThe founding truths of Excel Quality programme - DentistsDenplan Excel Quality programmeLaunched in 2001 following pilot in 2000

Provides dentists with complete package;Oral Health Score (c) for patientsRisk assessment for patientsSupporting patient information cards with BDHFBi-annual patient feedback survey18 monthly in practice assessmentDetailed audit requirements Record cards, X rays, TeamworkMeets requirement of regulators/commissionersNHS England HTM01-05

GDC

CQC

AgendaDenplan in context

The Denplan Excel Quality programme

Oral Health Score (c)

Denplan Excel Previser Patient Risk Assessment (DEPPA)WHO Oral HealthThe ability to eat, speak and socialise without active disease, decay or embarrassmentOral Health Score scientific backgroundBurke FJ and Wilson NH (1995)Measuring Oral Health: an historical view and details of a contemporary oral health index (OHX) - International Dental Journal 45: 358-370.

Burke F J T, Busby M, McHugh S, Delagy S, Mullins A, Matthews R. (2003)Evaluation of an oral health scoring system by dentists in general practice - British Dental Journal 194: 214-218Burke T, Busby M, Mchugh S, Mullins A, Matthews R (2004) - A Pilot Study of Patients Views of an Oral Health Scoring System - Primary Dental Care 11 (2) 37-39Delargy S, Busby M, McHugh S, Matthews R, Burke F.J.T. (2007)The reproducibility of the Denplan Oral Health Score (OHS) in general dental practitioners - Community Dental Health 24: 105-110

17Max ScorePossible scoresComfort80 (pain) 4(some pain) 8(no pain)Function80(problems) 4(minor problems) 8 (no problems)Appearance80 (unhappy) 4(some concern) 8(happy)Occlusion80 (less than 10 teeth in each jaw opposed)8 (at least 10 teeth in each jaw opposed)Soft Tissues80 (needs treatment or referral)4 (needs observation)8 (healthy)Tooth health 2424 (no restorations, caries free)18 ( sound restorations, caries free)12 (less than 10% teeth need treatment)6 (10-30% of teeth need treatment)0 (more than 30% of teeth need treatment)Tooth Wear120 (much more wear than expected for age)6 (more wear than expected for age)12 (normal wear for age)Gum Health240 (severe periodontal disease)6 (moderate periodontal disease)12 (mild periodontal disease)18 (gingivitis only)24 (healthy)TOTAL100

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Crucial elements of OHSPatient evaluation responsible for 24% of score

Meets requirements of WHO definition of oral health (measurement)

Identifies areas for improvement with resultant score improvementAgendaDenplan in context

The Denplan Excel Quality programme

Oral Health Score (c)

Denplan Excel Previser Patient Risk Assessment (DEPPA)

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25Validating the dataAverage Age% high / v high caries risk% caries or defective restns% high / v high perio risk% severe perio diseaseDEPPA5523%21%10%9%ADHS*4722%8%*The ADHS figures are for patients claiming to attend a dentist regularlyValidating the data age differentials

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30Average OHS for patient reported health and lifestyles factors (37,330 patients)31Simple audit

32The detailed audit report

33Summary of GDC Research (Dec 2009)5.2.3Ensure Integration with other Initiatives It is essential that revalidation ties in with other, already established initiatives to ensure that workloads are minimised for both the individual practitioner and the GDC. On the testimony of dentists themselves, we would recommend that the Denplan Excel certificate is enough to meet the requirements of revalidation as many feel that this covers off all of the outcomes more than adequately. Other popular initiatives such as BDA Good Practice should be considered so that certification from this is enough to meet the requirements of relevant outcomes.

George Street Research, Edinburgh. Final report to GDC. CQC 17 June 2010CQC, as far as we can answer at this stage,would view Denplan Excel accreditation as a good proxy indicator of quality and certainly it would be useful as contextual evidence in the QRP. As I understand it, Excel accreditation produces a wealth of data and this would stand the provider in good stead were it able to appear in the QRP. The accreditation flag on the QRP, coupled with the supporting data would go a long way towards satisfying an inspector/assessor that there was widespread compliance and it is likely that only if there were significant gaps, or a body of evidence to indicate non compliance with a regulation,would further investigation be necessary. Even then, this may not necessarily be an inspection

Joel Clark, Senior AnalystInformation Policy & Research (Intelligence)A growing scientific evidence/review base

What has been the feedback?Dentist Research - 2014

Patient Research - 2014

Base: All respondents (90)Patient Research - 2014

41DEPPA key benefits

Demonstrates competenceSupports good communicationReduces riskSupports qualitySupports patient retentionInforms risk based prevention `Clinical audit 42

ConclusionA world-leading scientifically-based innovation to;

Engage dental patients in their own oral health improvementSupport dentists in providing a structured risk assessmentEnsuring dentists meet all of their regulatory and clinical requirements

And all from here in Hampshire...

ThompsonJ

Dentist X

Total number of patients in NRS 24,486My patients 132Average Oral Health Score Recorded78My Average OHS77Average age of patients assessed54My Average age59Table 1NRSMy PatientsNRSMy PatientsNRSMy PatientsNRSMy PatientsNRSMy PatientsReflectionsAction Plan12345Perio Risk50%76%30%14%9%2%8%7%2%2%my age group is older and deepa reduces their risk of perio as they get older even when they have past history of perio disease- a lot of my patientswith perio disease have had extensive hygiene treatment, I think this is why it appears I have higher numbers of patients in the lower risk groups even though a lot more have gingivitisContinue to encourage good oral hygien measures and regular visits to the hygienistCaries Risk29%24%32%23%15%20%10%11%14%23%A patient is high risk if they have had a filling in the last 12 months or if they have a defective restorationcontinue to target patients who are susceptible to caries and offer advice,encourage dietary changes, leaflets, high fluoirde toothpaste prescription. The older patients often dont want to change their habitsTooth Wear Risk48%30%22%26%15%20%4%8%11%15%Deppa risk assesses patients as high if they say they have acidic foods daily or if they grind even when there is no evidence of wear and they fall into the older age groupcontinue to discuss dietary acid (often fruit) and offer corrective measures for patients who grind or who have worn their teethOral Cancer Risk56%48%19%22%12%16%6%7%7%8%similar to average. There may be some confusion with patients regarding drinks/units

Indicative Fee BandingABCDE10%3%34%35%41%49%12%9%2%4%My group of patients are older and have heavily restored dentitions - see tooth healthTable 2AspectHealth gradeNRSMy averagesReflectionsAction PlanPainYes4%3%similar to averageSome12%12%same as averageNo84%85%similar to averageFunctionYes4%5%similar to averageMainly7%13%I havent picked up on these patients when completing their deppasto discuss reduced function - possibly dentures?No89%82%lower than averageAestheticsHappy73%73%same as averageSome25%26%similar to averageto discuss concerns with aesthetics - its often that they arent completely happy but feel they are 'too old' to want to do anything about itUnhappy3%1%lower than averageSoft tissuesNo problem95.7%96.2%similar to averageObserve4%3%similar to averageTreat0.3%0.8%similar to averageRefer0%0%same as averageOcclusionAdequate95%95%same as averageInadequate5%5%same as averageWearNormal83%65%much lower than averageMore15%31%much higher than averagethe patients who I assess as having wear are not usaully the ones that deppa predicts as high riskMuch more1%4%higher than averageTooth healthHealth4%0%lower than averageRestored74%79%higher than averagemany of my patients fall into the older age group with heavily restored dentitionsMinor22%21%similar to averageModerate0%0%same as averageSevere0%0%same as averagePerio healthHealth16%7%lower than averageGingivitis24%47%much higher than averageI discuss bleeding and interdental care frequentlyMild35%32%similar to averageModerate15%6%much lower than averageSevere10%8%similar to average

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