AUDUBON CLINIC QUALITY IMPROVEMENT PROJECT Optimizing Dental Health
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.
AAP Recommendations Periodic oral health risk assessments Dietary counseling and anticipatory guidance Use of fluoride containing toothpaste Fluoride varnish application Established dental home by 1 year of age
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
Baseline Measurement: July 2011
Interventions PDSA Cycle 1 QI Didactic for Health Care Providers Age-Appropriate Dental Information Handouts Dental Clinic Referral Sheets
Age-Appropriate Dental Information Handouts
Dental Clinic Referral Sheets
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
Dental Screening Poster
Chart Review Patient Name
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
Dental Board
Chart Review: Results Table Baseline Measurement Phase After PDSA Cycle 1 After PDSA Cycle 2 After 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 ReferralsN/A 70 (7/10)
Percent of Patients Receiving Dental Referrals
Percent of Patients Receiving Dental Referrals A Different Way to Look at the Same Data
Percentage of Patients with Scheduled Dental Appointments
QI Project Final Chart Review: May 2012
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 ✔ ✔ ✔ ✔
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
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
Spreading QI Project to Other ACN Sites
Fluoride Varnish: The Next Step? o Fluoride varnish can be applied by a Pediatrician in office and by Pediatric Dentists o Fluoride Varnish is recommended for all high risk patients identified
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
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
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
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