Download - Optimizing Dental Health
![Page 1: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/1.jpg)
AUDUBON CLINIC QUALITY IMPROVEMENT PROJECT
2011-2012
Optimizing Dental Health
![Page 2: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/2.jpg)
Background
![Page 3: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/3.jpg)
Background
Dental caries prevalence: 41% of children between age 2-11 years 80% of children between age 5-18 years
Visit to physician/visit to dentist: 250/1 89% of <1 year old have physician visits 1.5% of <1 year old have dentist visits
Average wait time to see a Pediatric dentist in NYC is 3-6 months.
![Page 4: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/4.jpg)
AAP Recommendations
Periodic oral health risk assessmentsDietary counseling and anticipatory guidanceUse of fluoride containing toothpasteFluoride varnish applicationEstablished dental home by 1 year of age
![Page 5: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/5.jpg)
Aim Statement
Pediatric Dental Referrals:
Increase the percentage of patients referred to a pediatric dentist by 1 year of age from 10% to 40% by June 2012
Improve the teaching and anticipatory guidance for dental issues delivered by the pediatricians in our clinic
Include age based counseling for ages 1-3
Increase documentation of dental referrals and counseling
![Page 6: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/6.jpg)
Baseline Measurement: July 2011
10%
90%
12-15 month olds with Referrals to Pediatric DentistNo Referral Given to Pediatric Dentist
![Page 7: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/7.jpg)
Interventions
PDSA Cycle 1 QI Didactic for Health Care Providers Age-Appropriate Dental Information Handouts Dental Clinic Referral Sheets
![Page 8: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/8.jpg)
Age-Appropriate Dental Information Handouts
![Page 9: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/9.jpg)
Dental Clinic Referral Sheets
![Page 10: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/10.jpg)
Interventions
PDSA Cycle 1 QI Didactic for Health Care Providers Age-Appropriate Dental Information Handouts Dental Clinic Referral Sheets
PDSA Cycle 2 Signs hung in Rooms Informed MAs, Nurses, and PFAs PFAs given copies of referral handouts
![Page 11: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/11.jpg)
Dental Screening Poster
![Page 12: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/12.jpg)
Chart ReviewPatient Name
![Page 13: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/13.jpg)
Interventions
PDSA Cycle 1 QI Didactic for Health Care Providers Age-Appropriate Dental Information Handouts Dental Clinic Referral Sheets
PDSA Cycle 2 Signs hung in Rooms Informed MAs, Nurses, and PFAs PFAs given copies of referral handouts
PDSA Cycle 3 Staff Education Dental Board created in Hallways
![Page 14: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/14.jpg)
Dental Board
![Page 15: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/15.jpg)
Chart Review: Results Table
Baseline Measurement
PhaseAfter PDSA
Cycle 1After PDSA
Cycle 2After PDSA
Cycle 3
% of 12mo Dental
Referrals
10
(4/38)
25
(5/20)
80
(20/25)
50
(16/33)
% of 15mo Dental
Referrals
10
(4/38)
40
(4/10)
77
(17/22)
70
(14/20)
% of 18mo Dental
Referrals N/A N/A N/A
70
(7/10)
![Page 16: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/16.jpg)
Percent of Patients Receiving Dental Referrals
Baseli
ne M
easu
re...
After P
DSA Cyc
le 1
After P
DSA Cyc
le 2
After P
DSA Cyc
le 3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
10%
25%
80%
50%
10%
40%
77%
70% Dental Referrals 12mo
Dental Referrals 15mo
![Page 17: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/17.jpg)
Percent of Patients Receiving Dental Referrals
A Different Way to Look at the Same Data
12mo 15mo0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Perc
ent
of P
atie
nts
![Page 18: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/18.jpg)
Percentage of Patients with Scheduled Dental Appointments
Measurement After PDSA Cycle 1
After PDSA Cycle 2
After PDSA Cycle 3
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
12mo
15mo
![Page 19: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/19.jpg)
QI Project Final Chart Review: May 2012
12mo 15mo 18mo0%
10%
20%
30%
40%
50%
60%
70%
80%
Perc
ent
of P
atie
nts
![Page 20: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/20.jpg)
Aim Statement Revisited
Pediatric Dental Referrals:
Increase the percentage of patients referred to a pediatric dentist by 1 year of age from 10% to 40% by June 2012
Improve the teaching and anticipatory guidance for dental issues delivered by the pediatricians in our clinic
Include age based counseling for ages 1-3
Increase documentation of dental referrals and counseling
✔
✔✔✔
![Page 21: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/21.jpg)
Limitations and Difficulties
“No Teeth” recorded on multiple charts when reviewed No dental referral given at that time
Ultimate outcome measure of the project is that each child has a dental "medical" home Project was limited in its ability to measure this
Anticipatory guidance for 1 year visit in Eclipsys does not prompt dental referrals But the anticipatory guidance page for the 2 year visit does
![Page 22: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/22.jpg)
Limitations and Difficulties
“No Teeth” recorded on multiple charts when reviewed No dental referral given at that time
Ultimate outcome measure of the project is that each child has a dental "medical" home Project was limited in its ability to measure this
Anticipatory guidance for 1 year visit in Eclipsys does not prompt dental referrals But the anticipatory guidance page for the 2 year visit does
![Page 23: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/23.jpg)
Spreading QI Project to Other ACN Sites
![Page 24: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/24.jpg)
Fluoride Varnish: The Next Step?
oFluoride varnish can be applied by a Pediatrician in office and by Pediatric DentistsoFluoride Varnish is recommended for all high risk patients identified
![Page 25: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/25.jpg)
Alex Glick Jennifer Guimbellot Caitlin Haxel Marleine Ishak Elaine Lin Genevieve London Katie Offer Ryan Morgan Erin C. Qualter Shawndip Sen Evan Sherman Rebecca Turcotte
Doctors: Mariellen Lane Connie Kostacos Melissa Stockwell Valerie Niketakis Betsy Pfeffer Karen Soren Nikki Timko Betsy Wedemeyer Larry Williams Daryl Wisler
QI at Audubon
Jackie Baker Kelly Burke Nitin Chanana Wendy Chang Amelie Collins Danis Copenhaver Nina Dadlez Valerio Dorrello Pam Fazzio Cristina Fernandez Sarah Fleet
![Page 26: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/26.jpg)
QI at Audubon
Nurses Beverly Kim Diana Decharo Ernestina Amoah Estela Padron Jasmine Ortiz Adora Brown Vicki Bernstein
Medical Assistants Doreen Pittman Hasse Nolasco Ivette Pinto-Velez Jean Adedipe-Jonadu Jessie Lyons Stacyann Halm
Site Administrators and Patient Financial Advisors
Luis Brito Dulcelyn Caba Kecia Davis Roxanne DeSoto Alfred Mancebo Vivian Yajayra Rojas Yoima Sosa Kim Moore Steele Tina Veloz
![Page 27: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/27.jpg)
QI at Audubon
Nurses Beverly Kim Diana Decharo Ernestina Amoah Estela Padron Jasmine Ortiz Adora Brown Vicki Bernstein
Medical Assistants Doreen Pittman Hasse Nolasco Ivette Pinto-Velez Jean Adedipe-Jonadu Jessie Lyons Stacyann Halm
Site Administrators and Patient Financial Advisors
Luis Brito Dulcelyn Caba Kecia Davis Roxanne DeSoto Alfred Mancebo Vivian Yajayra Rojas Yoima Sosa Kim Moore Steele Tina Veloz
![Page 28: Optimizing Dental Health](https://reader033.vdocuments.net/reader033/viewer/2022051118/56816412550346895dd5c196/html5/thumbnails/28.jpg)
References
o http://www.usetinc.org/Libraries/THPS/Fluoride_Varnish_Manual.sflb.ashxo http://pediatrics.aappublications.org/content/115/1/e69.fullo http://www.youtube.com/watch?v=8A5jrVuxSHco http://www.aapd.org/media/Policies_Guidelines/G_CariesRiskAssessment.pdfo http://pediatrics.aappublications.org/content/122/6/1387.full.pdf+html