DATA WATCH Success for a novel approach to priority setting in South Australian public dental clinics Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia. INTRODUCTION There is increasing use of prognostic models to sup- port evidence based delivery of health care. However, widespread application of such models for use in pub- lic dental services to assist in predicting priority of need or treatment planning for patients is not com- mon. Prognostic models facilitate transparent and consistent decision making and remove many of the subjective elements of traditional receptionist methods in determining relative priority between patients call- ing for same day ‘emergency’ care. Pressures on the Australian public dental system often mean that people are forced in to recidivistic patterns of emergency dental care, receiving treatment only when pain initiates contact with dental health care providers or an inability to access general preven- tive dental care. Long waiting lists and waiting times for general dental care and an increasing reliance on emergency dental appointments to secure dental care indicate that public dental services are struggling to meet the needs of the community. 1-3 Contemporary Australian dental health literature consistently sug- gests that it is a lack of timely and comprehensive access to oral health services that generates oral health inequalities in Australia. 4,5 Consequently, those rely- ing on public dental services are placed at risk of poor oral health outcomes. 4–6 Historically, people seeking priority care with the South Australian Dental Service are allocated care on a ‘first come first served’ basis where self reported need has been used as the criteria for access to care. The South Australian Dental Service provides general or basic dental care to 87 000 low income adult patients annually. In 2005–2006, approximately 57% of treated patients had sought ‘urgent’ care (n = 52 000). The small proportion (<1%) with life- threatening infection, trauma, etc. are seen on the day they seek care. 7 However, resources do not permit all other patients to be seen on the same day. Reception staff have traditionally acted as the gatekeepers to public dental care. This has required the use of subjec- tive judgement by non-clinicians about a person’s clin- ical need, based on their self reported symptoms and typically reception staff have tried to accommodate peoples’ requests for same day care. In response to the need for systematic and transpar- ent demand management strategies in South Australia (SA), some clinics administered basic priority systems, developed by reception staff, using reported oral symptoms. None of these approaches have been vali- dated nor officially mandated or supported by the dental service. A substantial (unknown) minority are denied care. There had been concern that reception- ists’ judgements were both inaccurate – possibly allowing higher proportions of people to be treated more urgently than was necessary, and inconsistent leading to inequity between equally deserved patients, both within and between clinics. These equity factors were a primary driver in the development and testing of a new triage method known as the Relative Needs Index (RNI) prognostic model in an attempt to be able to quickly screen, identify and prioritize those patients who might most benefit from care. Develop- ment and testing of this prognostic model (which comprises eight questions) is reported elsewhere. 8,9 This report uses data from two distinct data collec- tion phases to test the accuracy and clinical efficacy of the model on a sample of SA Dental Service patients by the Australian Research Centre for Population Oral Health and the SA Dental Service. The prognos- tic accuracy of this novel RNI model was tested against both a gold standard assessment of priority (as determined by dental officers) and compared with the traditional assessment of priority by reception staff. Accuracy of the model is reported using the tra- ditional classification probabilities of sensitivity, speci- ficity and predictive values. The RNI model was then tested for efficacy on a new sample of SA Dental Service patients. In studies of diagnostic tests with quantitative test results and a dichotomous reference standard, the rela- tion of sensitivity and specificity for possible cut-off points can also be presented as a receiver operating characteristic (ROC) curve and its summary statistic, the area under the curve (AUC) is reported. 378 © 2013 Australian Dental Association Australian Dental Journal 2013; 58: 378–383 doi: 10.1111/adj.12094 Australian Dental Journal The official journal of the Australian Dental Association