Management of dental clinics by the use of informatics

University dissertation from Stockholm : Karolinska Institutet, Department of Learning, Informatics, Management and Ethics (Lime)

Abstract: The main objective with this project has been to develop a tool for close to-the-clinic health-care management, based upon ways of measuring which are interpretable both by profession-als as well as by patients. This would be a tool that collects and compiles data related to the dental health situation, permitting an overview of a dental clinic, and thus facilitating the management of dental-health improvements. This thesis is based upon four different studies. The first study was initiated in a private dental clinic with the aim of creating a system of codes representing a summary of a patient s dental-health situation. Interviews and discussions with specialists in the field of periodontology and cariology were held. Literature searches were performed as well as different tests in the dental clinic. The result became the HIDEP model (Health Improvement in Dental Practice) a health management tool based upon a preventive and tissue-saving approach. The code consists of the number of intact teeth and total number of teeth, together with a cariological and a perio-dontal grouping system defining where a patient is found upon a Health Disease scale. The second study aimed to develop a dedicated software system, supporting the work accord-ing to the model. Both model and software were tested and further developed in dental clinics in Sweden, Germany and the United Kingdom. Questionnaires, interviews and reports con-cerning the dental-health situation of the clinics were performed. The result became the DentiGroup software system. It compiles the codes into a Health profile that presents an overview of the dental-health situation of a dental clinic, from which close-to-the-clinic healthcare planning can start. The software also comprises functions such as risk analysis, automatic suggestions of codes, information leaflets, treatment plans, etc. A retrospective cohort study was performed on 750 consecutively selected patients during a ten-year period to study if it was possible to follow up the dental-health situation over a longer period of time, as measured by the HIDEP codes. Data accessed from daily work ac-cording to the model was continuously registered, compiled and extracted from the software and assembled in a way which focused on the amount of saved dental tissues. 97.1% of the total number of teeth remained and 96.6% of the intact teeth were kept intact. 94.8 % of the patients kept their attachment according to limits of defined periodontal group. The co-operation of the patients is essential to success in dental healthcare. A fourth study was performed in order to evaluate if work according to the model had any effect on the den-tal awareness of the patients. A comparative, cross-sectional study, using a questionnaire distrib-uted in a consecutive way to 500 patients of three different types of clinics using either our model or another systematized preventive model, was performed. The result was that there were no differences concerning cariological knowledge between the clinics, but the awareness of periodontal diseases was significantly higher in a clinic using the HIDEP model for several years. The HIDEP Model and its supporting software DentiGroup focuses on the clinical dimen-sion of health disease but, together with dimensions of economy and well-being, it seems to be a tool for defining outcome of dental healthcare, and as a such is also a tool which manages and steers the development within a dental clinic by the support of Informatics.

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