Identifying Clinical Variations Across NSW Public Dental Service: An Essential Step to Develop a Roadmap for Value-Based Oral Healthcare.

Abstract

Objective: This research examines the extent of clinical variation across the NSW public dental service, the largest in Australia. Findings may assist policy makers in reducing variation of care and inequity towards value-based oral healthcare.

Methods: Four years of demographic and treatment data, for 741,450 patients between 1 July 2019 and 30 June 2023, were extracted from the Electronic Oral Health Record System and analysed. Sixteen common dental treatment types provided by NSW Local Health Districts (LHDs) for adults and children were analysed relative to all treated patients in terms of clinical variation. Adult-only treatment types included posterior root canal treatment, fixed crowns, occlusal splints and metal-based partial dentures, removal of calculus, as well as full dentures and acrylic partial dentures. Also included, were simple fillings and simple extractions for both adults and children, as well as preformed crowns, pulpotomy, sport mouthguards, treatment under nitrous oxide gas sedation, fissure sealing and fluoride application for children.

Results: Of the 16 total treatment types investigated, eight showed significant variations ranging between 43-961 fold for adults and 17-434 fold for children. In contrast, eight treatments showed far less variation ranging between 1.5 and 2.8 fold.

Conclusion: This research identified significant variations in general dental adult and child treatments provided across NSW LHDs which cannot be attributed or explained demographically. The presence of unwarranted clinical variation would suggest disproportionate and inequitable care delivery across NSW public dental services. Addressing unwarranted clinical variation will likely promote fairer and more equitable provision of public oral health with enhanced patient outcomes.