AUDUBON CLINIC QUALITY IMPROVEMENT PROJECT 2011-2012 Optimizing Dental Health.
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Transcript of AUDUBON CLINIC QUALITY IMPROVEMENT PROJECT 2011-2012 Optimizing Dental Health.
AUDUBON CLINIC QUALITY IMPROVEMENT PROJECT
2011-2012
Optimizing Dental Health
Background
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 assessmentsDietary counseling and anticipatory guidanceUse of fluoride containing toothpasteFluoride varnish applicationEstablished 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
10%
90%
12-15 month olds with Referrals to Pediatric DentistNo Referral Given to Pediatric Dentist
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
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)
Percent of Patients Receiving Dental Referrals
Basel
ine
Mea
sure
...
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
Percent of Patients Receiving Dental Referrals
A Different Way to Look at the Same Data
12mo 15mo
Baseline Measurement 0.1 0.1
After PDSA Cycle 1 0.25 0.4
After PDSA Cycle 2 0.8 0.77
After PDSA Cycle 3 0.5 0.7
5%
15%
25%
35%
45%
55%
65%
75%
85%
Per
cent
of
Pat
ients
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
QI Project Final Chart Review: May 2012
12mo 15mo 18mo
dental referrals 0.424242424242424
0.65 0.6
dental appointment scheduled already
0.0606060606060606
0.05 0.1
5%
25%
45%
65%P
erce
nt
of
Pati
ents
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?
oFluoride varnish can be applied by a Pediatrician in office and by Pediatric DentistsoFluoride 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
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