Friday, October 31

All about 'The Thing'

ive thought about doing a post about 'the thing' off and on for a while and always thought the better of it. i mean does anyone really want to know? well, apparently some of ya do! Writing up a precis is a good chance for me to conslidate, as i still have my thesis abstract to write. You're it, my guinea pigs, so if its all gobbledygook, let me know. Its pretty hard to spice up mathematical modelling and public health, but i'll give it my best shot and try and explain why its recieved the attention it has. Its also pretty hard to stand back and not be too scientific and dogmatic about how i tell the story. Im so used to systematic and technically correct (scientific) writing!

Umm, background. My field is oral epidemiology; epidemiology is the science of looking at the determinants and distribution of diseases (who gets what and why). By its nature, epidemiology concerns itself not with the biology of disease but the public health context of illness/wellness.

The research question i set out to answer was ' can we develop an index by which the relative urgency of an individuals need for dental care can be determined?'. The reason i was interested in doing this research is that in the public sector, receptionists were making decisions about who got to see a dentist and who didnt and it appearred that in a lot of cases they were giving emergency priority to people who were not really urgent. Also, by tradition, people were given appointments on a first come first served basis, not urgency of need.

This work has been about 10 years in the making and it started with a very long series of questions asked to a large random selection of persons presenting to public dental clinics in two states of australia for both emergency and general dental care. These questions covered just about everything to do with an individuals oral health; hygiene practices, sugar consumption, dental visiting behaviours, medications taken, pain perceptions, sociodemographic characteristics, past dental treatments, etc. We asked pretty much everything about everything. These persons were then tracked through the dental system and all treatment provided to these people was recorded. Two dentists also provided independent opinion about the urgency of each patients dental problem.

Then i used statistics to match up question responses with dentists urgency categories to see if any questions were highly associated with urgency. This analysis resulted in 10 very predictive questions.

You still with me?

These questions were then tested on the computer on a pretend set of patients to see if the same questions would still be useful in predicting urgency and it wasnt just chance that led us to these 10 questions. They were. This is about 4 years of work so far. Research is like that. it takes ages when you deal with human populations. Give me a test tube! Ok!.. the questions work well in predicting urgency when i use a fake set of people. what about real people?

So then i took these 10 questions and had receptionists use them on the phone on real patients. I had dentists again rate the patients urgency. This was the first test of the questions on a new set of real people. After more analysis, the questions still matched up well with dentists ratings. What really 'Wowed' us was that the 10 questions worked better than receptionists at figuring out who needed most urgent care and was more like the dentists rating of urgency. Im getting excited now. It looks like i have found a systematic way to determine urgency for dental treatment.

Soo, then the public dental service gets all excited about my results and decides to let me do a full trial using my predictive model. They give me 4 clinics to run the trial and we actually say 'yes' or 'no' to people using responses to my series of questions. New computer interfaces for the dental clinic databases were made and installed and my special algorithm runs quietly in the background and calculates scores to peoples responses. It then tells receptionists the urgency category of each person calling and how long until an appontment should be made.

I do even more analysis and the questions still identify people with the most urgent need. It gets even better. Gasp, 'how can that possibly be'? i hear you all crying! This new way of determining need also lets the system better manage its bookings and over a year of using my system, these 4 clinics manage to change their service around from being mostly an emergency system;extracting rotten teeth which hurt, and start giving people check ups as well; looking after teeth, providing fillings and helping people keep their teeth healthy.

Before i have finished my dissertation, the system is rolled out in every clinic in the state and now all clinics are able to provide routine check ups for public dental patients, not just emergency dental services. It was a very thorough and scientifically rigourous piece of health services research using 'gold standard' design, process and analysis AND its had a great public health result. Hence its award nomination. Wheeeeee!


Rixa said...

Wow, now I am REALLY impressed with what you have done! It makes sense to me. Here's a suggestion for writing it up into a precis/abstract (especially one intended for a wider audience, ie, one talking to "lay" people like me):

Start by explaining the initial problem (receptionists deciding who gets appointments and when, which leads to poor efficiency and treating those who could wait, while turning away those who really need that urgent care). Then, once your audience understands the basic problem with the traditional approach to filling urgent/emergency appointments, you can then narrate the series of epidemiological and research steps you took to find a more methodological and efficient solution. Make sense? That way the audience knows from the get-go the significance of the problem and has a sense of what needs to be done to fix it.

Now I have a burning question--is this series of questions and the computer models something you can patent/sell/etc? In other words, will it make you "rich" as well as famous? LOL

porkchop said...


Laura Jane said...

Super work!

It all made perfect sense. I used to work in shared rooms with a dentist, and the problem of getting an appt was very real, and there didn't seem to be a systematic approach to dental triage. The fact that it cxan be integrated with an appt system with estimated appt durations etc is fantastic.

Has this nomination given you the impetus to finish off the write-up?

wombat064 said...

Well done Kel,
I understood what you are talking about.

Julie said...

Sensational Kel! I love that you are addressing such a pressing issue in Australia too where - it seems to me - the waiting times for public dental care is disgraceful, AND - as we are now discovering - dental health issues can lead to numerous other health issues. *Applause, applause* :-)

Veggie Gnome said...

Made perfect sense to me. I can understand why you get/got excited, for it to come together like that... I also like that you dealt with a practical issue in your thesis.

Just don't talk mathematical to me - I'd get lost within a second. ;)

naturewitch said...

Hi Kel

Great work! Glad to hear you're being nominated for an award.

Thesis writing can be such a gut-churning experience and I truly sympathise with explaining the mathematical component - try explaining computer models of laser-electron interactions! (Fortunately, far behind me now!).

love and light

Kel said...

Rixa- thanks and 'i wish', but the university owns all intellectual property!

Porkchop- well, thanks for a great first ever comment on my blog!

Laura Jane-appreciate your comments and 'no'- it has reinforced the fact that i can continue on leave and think about it when i go back to work! LOL
Wombat - fank yew too
Julie, yes- dental is very underated in regard to impact in the community. its the no.1 cause of missed work days! Thanks for the claps!
Veggie G- exactly, very satisfying. and dont worry, i dont talk math, the rest of my blog is testimony to that!
naturewithc. Hi and thanks. laser electron interactions, interesting, but difficult to deliver i do agree!

Rixa said...

Ahhh, I dream of some day living in a country that had a public dental health system. I had to go for 5 years with no checkups because my insurance at 2 different universities didn't cover dental. Luckily my teeth were none the worse off once I got dental insurance again.

elburro said...

Thanks for that Kel. I was hoping you wouldn't mind letting us in on your research. Even though it's taken such a long time (well, not really, considering the impact it will make, but a hell of a long time in your life) it must have been, and still be, terribly exciting. I'll bet that not many researchers get to see such tangible evidence of all of their hard work.

Kel said...

Rixa- yes, living in America seems to me pretty stressful that way. I can never understand why our governments sometimes want to head in that direction???

elburro- no worries (as we like to say down here). its exciting and stressful at the same time. as its based on probablities, there will always be those for whom the models dont work. i have built safety nets into the system but its not foolproof. overall, i couldnt ask for more from a piece of research. i have been very fortunate.