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The European Journal of Orthodontics Advance Access published online on August 7, 2008
The European Journal of Orthodontics, doi:10.1093/ejo/cjn036
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© The Author 2008. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org.

League tables for orthodontists

Frank Dunstan*, Stephen Richmond**, Ceri Phillips*** and Peter Durning**

* Department of Primary Care and Public Health
** Department of Dental Health and Biological Sciences, Cardiff University
*** Department of School of Health Science, University of Wales, Swansea, UK

Address for correspondence Professor Frank Dunstan, Department of Primary Care and Public Health, Cardiff University, Cardiff CF14 4YS, UK, E-mail: dunstanfd{at}cardiff.ac.uk


  Abstract

The aim of this study was to explore the complexities in constructing league tables purporting to measure orthodontic clinical outcomes. Eighteen orthodontists were invited to participate in a cost-effectiveness study. Each orthodontist was asked to provide information on 100 consecutively treated patients. The Index of Complexity, Outcome, and Need (ICON) was used to assess treatment need, complexity, and outcome prior to, and on completion of, orthodontic treatment. The 18 orthodontists were ranked based on achieving a successful orthodontic outcome (ICON score less than or equal to 30) and the uncertainty in both the success rates and rankings was also quantified using confidence intervals.

Successful outcomes were achieved in 62 per cent of the sample (range 19–94 per cent); four of the 18 orthodontists failed to achieve more than a 50 per cent success rate. In developing league tables, it is imperative that factors such as case mix are identified and accounted for in producing rankings. Bayesian hierarchical modelling was used to achieve this and to quantify uncertainty in the rankings produced. When case mix was taken into account, the four with low success rates were clearly not as good as the top four performing orthodontists.

League tables can be valuable for the individual orthodontist, groups of orthodontists, payment/insurance agencies, and the public to enable informed choice for orthodontic provision but must be correctly constructed so that users can have confidence in them.


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