Community Research and Development Information Service - CORDIS


ADVOCATE Report Summary

Project ID: 635183
Funded under: H2020-EU.3.1.

Periodic Reporting for period 1 - ADVOCATE (Added Value for Oral Care)

Reporting period: 2015-05-01 to 2016-10-31

Summary of the context and overall objectives of the project

What is the problem being addressed?
Oral care has an annual cost in EU of €79 billion. Tooth decay, advanced gum disease and tooth loss, are largely preventable conditions. Many dental treatments represent repair of the damage caused by the disease rather than curing or stopping the disease process itself.

Societal impact: ADVOCATE has a vision of achieving a step change in health systems design and performance. This project will establish an innovative framework to bring health system planning into the 21st century.
Policy and planning of services and care systems, have emerged in the absence of robust information on the outcomes of alternative models of care. Health decision making will soon benefit from the use of data analysis on a large scale, which was previously not possible. The collection and analysis of real data about the population will transform the way in which policy decisions are made.

The mission of ADVOCATE is to establish an innovative evidence-informed oral health care model which is patient-centred, prevention-oriented, delivers safe and efficient care and is sustainable.

Objectives: To develop:
1. A new type of healthcare model that promotes patient centred, prevention oriented care
2. A set of indicators to measure progress in preventing unnecessary treatment
3. Evidence which guides decision makers in better health systems planning

Methods include stakeholder engagement interviews, focus groups and surveys, a patient App and a feedback dashboard.
Analysis of current policy and historical changes.
Identification of agreed indicators of oral health outcomes to enable comparisons and identification of good design/practice
The acquisition and analysis of existing patient data
Field testing of new model

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

What progress has been made during the first 18 months?
All milestones and deliverables have been achieved on schedule and as agreed.
Consortium agreement signed
Staff recruited to the projection each country
Reporting relationships and processes established
Web site developed
Overview of the study has been published in a peer reviewed journal.
The following committees have been populated and have met on an agreed schedule: Executive Board, General Assembly, Scientific Advisory Board, Ethics Committee, Stakeholder platform
All activity has been underpinned by extensive discussion in all six ADVOCATE countries – England, the Netherlands, Germany, Denmark, Hungary and Ireland. The opinions of patients, policy makers, the healthcare professionals and the oral care products (e.g. toothpaste) industry have all contributed.
All stakeholders have been informed of the detail of the project and actively consulted in a series of focus groups, interviews, workshops and meetings including two AGMs. Feedback has been invited and responded to in planning the work.
Stakeholder preferences and opinions about measures that indicate the quality of care have been explored through a Delphi process and World Cafe round table discussion and voting. This extensive consultation exercise with a representative group of stakeholders in oral health care (including patient and public representation) resulted in a long list and subsequently a short list of process and outcome indicators. These indicators will be used to measure current performance and to compare to the future position after changes have taken place. A paper describing the process has been submitted top a peer reviewed journal for consideration for publication.
An extensive survey of the published literature has taken place, to discover what are the barriers and facilitators to changes in the systems in the participant countries.
Scenarios for a patient journey for the same patient presenting for dental care in each system under consideration in each country has been developed to communicate the differences in system design an understandable way. The scenarios paper will be submitted to a peer reviewed paper for publication.
Ethical and data protection compliance challenges have been addressed,
Oral health data has been accessed from 6 insurance systems in 5 countries and analysis, based on the outcome indicators, is taking place. Work is ongoing in the 6th country and is on target to deliver the required information. Data collected, which at source contains patient names, has been anonymised so no individual can be identified when the analysis is taking place. All ethical and data protection laws have been carefully followed.
Patient engagement is facilitated through a patient 'App' which is designed to the data collection and incorporate the patient perspective.
The 'App' has been built, tested and translated into four languages (English, Dutch, German and Danish). It has been trialled in two dental practices in the Netherlands.
Work is in progress to identify key indicators from the short list of stakeholder identified measures, these will ultimately be incorporated into an electronic dashboard to give feedback at dentist and insurer levels. A preliminary version of this electronic Dashboard display has been created and tested with mock data.
The project will proceed to field testing the use of the App and dashboard in general dental practices in 2017. The potential to motivate practitioners to carry out more preventive care using the newly developed feedback system and patient App will be explored in detail in a series of field studies. Ethical approval for this study has already been granted in Germany and Denmark. The first wave of field studies will take place in Denmark, The Netherlands and Germany commencing in the first half of 2017.
Experienced General Dental Practitioners have been recruited in each of the first wave countries preparations for training the dental practitioners who will help with the field studies and testing of the Dashboard and the App are underway.
Planning is underway for two data conferences, the first to take place in April 2017, this meeting will convene relevant international experts to consider the challenges and potential solutions and regulatory needs to facilitate the analysis of big health service data sets.
Support has been awarded by the EU to develop our exploitation plan with the advice of exploitation experts. The consultants have been identified and the first meeting will take place in January 2017. The process will involve all partners.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The ADVOCATE project has chartered new territory by providing a forum and establishing a dialogue among health services researchers, dental professionals, policy makers, administrators of third party funded payment systems for oral care and patients.
It has identified the outcomes of interest to all stakeholders using an innovative participative consultative approach. It has also developed a route to access administrative data for outcomes analysis for 8 different health services in 6 EU countries. This work progressed the state of the art in outcomes research for oral health services and paves the way for the next stage of the project which will finalise feedback mechanisms and motivate a greater focus on preventive care in general dental practice.
The impact of the work to date is on raising awareness of the importance and potential value to health service users oral health, of analysis of service data to provide feedback on outcomes of care to practitioners and service funding agencies.
The work to date represents substantial progress towards the ultimate goal of the project.

Related information

Record Number: 196396 / Last updated on: 2017-03-29
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