Key Points
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Yearly consultant appraisal is now a reality, and part of the appraisal folder includes 'results of clinical outcomes as compared to Royal College, Faculty or speciality association recommendations, where available'.
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It is important when setting standards that a focused and robust benchmark is developed, against which the treatment outcomes of individual consultants can be fairly assessed.
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This paper sets out to develop such a standard, and also discuss some of the wider issues surrounding appraisal and personal audit.
Abstract
Bristol's much-publicised cardiac surgery problems and subsequent enquiry1 have drawn attention to the need for audit of treatment outcomes throughout all hospital specialties. Patient anxiety, government policy and the desire of the professions to re-establish public confidence, have further encouraged changes to the system. For medical and dental specialities, such challenges have already been taken up by the Royal Colleges with the establishment of clinical effectiveness committees. Hospitals have modified their procedures and, for consultants, yearly appraisal is already a reality. The Orthodontic Clinical Effectiveness Working Party of the Royal College of Surgeons of England (now the Clinical Effectiveness Committee of the British Orthodontic Society) set up this audit to measure the outcome of fixed appliance treatment and to establish a benchmark for the standard of treatment to be expected from a consultant orthodontist. This paper describes how the audit was carried out, presents the findings and goes on to discuss some of the wider issues involved in audit, clinical governance and appraisal. The Consultant Orthodontists Group of the British Orthodontic Society funded this audit and the results and data set of dental casts remain their property.
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References
The report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995: Learning from Bristol (Cm 5207) The Stationary Office. July 2001
Brook PH, Shaw WC . The development of an index for orthodontic treatment priority Eur J Orthod 1989; 11: 309–332
Burden DJ . Need for orthodontic treatment in Northern Ireland Community Dent Oral Epidemiol 1995; 23: 62–63
Richmond S, Shaw WC, Roberts CT, Andrews M . The PAR Index (Peer Assessment Rating): methods to determine outcome of orthodontic treatment in terms of improvement and standards Eur J Orthod 1992; 14: 180–187
O'Brien KD, Shaw WC, Roberts CT . The use of occlusal indices in assessing the provision of orthodontic treatment by the Hospital Orthodontic Service of England and Wales Br J Orthod 1993; 20: 25–35
Richmond S . Personal audit in orthodontics Br J Orthod 1993; 20: 131–145
Fox NA . The first 100 cases; a personal audit of ortho-dontic treatment assessed by the PAR (Peer Assess-ment Rating) Index Br Dent J 1993; 174: 290–297
Taylor PJS, Kerr WJS, McColl JH . Factors associated with the standard and duration of orthodontic treatment Br J Orthod 1996; 23: 335–341
Buchanan IB, Russell JI, Clark JD . Practical app-lication of the PAR Index: an illustrative comparison of the outcome of treating using two fixed appliance techniques Br J Orthod 1996; 23: 351–357
Birkeland K, Furevik J, Boe OE, Wisth PJ . Evaluation of treatment and post-treatment changes by the PAR Index Eur J Orthod 1997; 3: 181–185
al Yami EA, Kuijpers-Jagtman AM, van't Hof M A . Occlusal outcome of orthodontic treatment Angle Orthod 1998; 68: 439–444
Burden DJ, McGuinness N, McNamara T . Treatment outcome for a sample of patients with Class 11 division 1 malocclusion treated at a regional hospital ortho-dontic department J Ir Dent Assoc 1998; 44: 67–69
Riedman T, Berg R . Retrospective evaluation of the outcome of orthodontic treatment in adults J Orofac Orthoped 1999; 60: 108–123
Mars M, Plint DA, Houston WJB, Bergland O, Semb G . The Goslon Yardstick: a new system of assessing dental arch relationships in children with unilateral clefts of the lip and palate Cleft Palate J 1987; 24: 314–322
Atack NE, Hathorn IS, Semb G, Dowell T, Sandy JR . A new index for assessing the surgical outcome in unilateral cleft lip and palate subjects aged 5 – reproducibility and validity Cleft Palate-Craniofac J 1997; 34: 242–246
Richmond S . Personal communication, July 2002
Acknowledgements
The authors wish to acknowledge the help of the many people, without whom this audit would not have been possible.
The Consultant Orthodontists Group of the British Orthodontic Society, which provided the funding, and for the hard work of the past Hon. Sec, Miss Helen Knight, who compiled the original main consultant orthodontist list.
The Clinical Effectiveness Committee of the Royal College of Surgeons of England, for their support, invaluable advice and encouragement.
Mr Mark Shields, for the IT support, and the setting up, running and retrieval of information from the audit database.
Mrs Jacinta McDermott, for the administrative support, the data entry to the audit database, and the fielding of endless calls from 'confused' consultant orthodontists.
The Bristol Dental Hospital Orthodontic Laboratory, for all the PAR Index analysis. Their interest and support added to the validity of the whole project. The technicians involved were:
Peter Gleed, Chief Tech. Orthodontics
Rob Edge, Senior Tech.
Ashley Hunt, Senior Tech.
Michelle George, Senior Tech.
Katie Spicer, Senior Tech.
Mark McGrath, Senior Tech.
Most of all, the authors would like to thank the consultant orthodontists who responded to the audit, and who offered encouragement and at times humour to the project. Their vision of the importance of clinical audit and personal appraisal to the quality of care of their patients, made this audit possible.
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McMullan, R., Doubleday, B., Muir, J. et al. Development of a treatment outcome standard as a result of a clinical audit of the outcome of fixed appliance therapy undertaken by hospital-based consultant orthodontists in the UK.. Br Dent J 194, 81–84 (2003). https://doi.org/10.1038/sj.bdj.4809878
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DOI: https://doi.org/10.1038/sj.bdj.4809878
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