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ABSTRACT
ObjectivesThe multi-country-EU project ADVOCATE (Added Value for Oral Care) involves the analysis of routinely collected oral health care records from health insurance systems in six European countries, including NHS England and NHS Scotland. The data will be stored in a in a central repository using AnalytiXagility which adheres to strict privacy and security standards. Therefore, data usage agreements must be consented with all partners and being subjected to specific regulations in the respective nation. This will result in different aggregation levels for data integration, e. g. one of the partners does not allow the transfer of data that contain a personal identifier. To understand the variety of requirements and limitations in different countries, we performed a qualitative content analysis of the agreements.
ApproachA categorisation system for privacy and data protection aspects was developed. The aspects are based on privacy conditions mentioned in guidance documents, the agreements themselves and the project's proposal. The agreements were examined for textual elements and systematically coded by three reviewers. Compliance between privacy conditions and the agreements was estimated using a nominal scale, whether the context was available in the agreement or not. The software MAXQDA was used for tagging relevant text passages.
ResultsThe initial coding scheme contains eight categories on top-level. They include, inter alia, aspects on data access, -preparation, -transmission, and -usage. The top-levels divide in up to four different levels of detail. The coding system was continuously adapted during full-text analysis. Initially, the agreements from the partners of Denmark and Germany were used. Characteristics in the agreements require a fine granularity of sub-categories. The German agreement, for example, names the whole institution as partner, whereas the Danish agreement differentiates in personal roles, each with own responsibilities.
ConclusionUndertaking an overview of privacy conditions can be a valuable step in comparing privacy and security requirements in different national regulations. The qualitative content analysis was found a suitable approach for this purpose because it enables the detection of fine characteristics. By using an incremental design, it is possible to adapt the coding system to include additional partners. However, the current coding system has the limitation that heterogeneity between the agreements leads to a fine granularity of categories that hamper the comparability between partners. Despite these problems, the approach allows the comparison of data privacy and supports the development of a data integration process for international harmonisation.

ABSTRACT
ObjectivesOral diseases are highly prevalent worldwide and their treatment places considerable economic burden on individuals and society. The ADVOCATE (Added value for Oral Care) project aims to promote new, patient-centred preventively oriented primary care and treatment.
As part of the project, a benchmarking dashboard is being developed to give stakeholders (i.e. health professionals, policy makers and health service planners) access to routinely collected data through a number of indicators such as: the types of care provided, costs of care and care outcomes, enabling comparisons across countries to be made.
ApproachAt the core of the ADVOCATE project, health data from several European countries are being collected. A bidirectional approach is used. Routinely collected claims data from 9 health insurers (insurance companies and NHS schemes) are being gathered. Concurrently, a patient e-questionnaire is being developed. Patients will be asked to answer additional health information questions anonymously whilst in the dental practitioner's office using an app, thus providing data that isn't available through the routinely collected claims data.
A previously developed set of indicators is being implemented in an electronic benchmarking dashboard. With the help of the linkage of aggregated forms of both claims data and data from the patient e-questionnaire, the dashboard will be used to visualize these indicators in order to monitor, direct and evaluate system change and related behaviors of patients, professionals, policymakers and insurers.
ResultsA pilot version of a dental healthcare dashboard has been developed using data from the Survey of Health, Aging, and Retirement Europe (SHARE).
In this context, the number of remaining teeth (indicating oral health status), the proportion of replaced teeth (indicating restorative activity of dentists) and the mean number of dentist visits per day (indicating oral health awareness of the population) were modeled and visualized for 12 European countries and Israel, resulting in highly diverse country groups in terms of the above indicators.
ConclusionThe ADVOCATE oral healthcare dashboard, containing essential information from both claims data and data from a patient e-questionnaire (via an app), can be used to review compliance with best practice guidelines and help close the guideline implementation gap.
It will be the first time that oral health professionals, insurers, and health policy makers will have the opportunity to review oral health care performance against standards.
This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 635183".