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Using Quality Improvement Methods to Implement an Early Childhood Oral Health Initiative: A Federally Qualified Health Center Pilot Study
1Department of Pediatric Dentistry and Pediatrics, Schools of Dentistry and Medicine, University of North Carolina, Chapel Hill
2Emory University, Chapel Hill
3Piedmont Health Community Center, Chapel Hill.
DOI: 10.17796/1053-4628-41.5.351 Vol.41,Issue 5,September 2017 pp.351-357
Published: 01 September 2017
*Corresponding Author(s): Rocio B Quinonez E-mail: rocio_quinonez@unc.edu
To assess the use of quality improvement (QI) methods to implement an early childhood oral health program (Baby Oral Health Program- bOHP) in four federally qualified health center (FQHC) dental clinics. Study Design: Using a mixed-methods study design, survey responses, administrative data, QI project templates, and focus group measures were collected. Plan-Do-Study-Act (PDSA) cycles as mini-projects to improve the implementation of bOHP were examined. Data analysis included descriptive qualitative reviews and quantitative statistics at baseline, six, and 12 months following the intervention. Results: Twenty-three dental team providers in one urban and three rural clinics participated. Successful QI mini-projects included shortening time period between accepted referral and patient visits, improved documentation of caregiver interview, and efficiency of the infant oral health examination. Lack of change in provider confidence was observed, regardless of years of practice (p=0.93), years of employment (p=0.39), and dental team age (p=0.85). Qualitative reviews highlighted mixed QI results related to training and limited resources invested on follow-up of QI implementation. Conclusions: A low cost, low resource pilot QI program as part of bOHP implementation showed mixed success, highlighting the critical role of training, staff committment, and leadership support to assure sustainable oral health programs in high-risk populations.
quality improvement, infant oral health, safety-net dental clinics
Rocio B Quinonez,Elizabeth Consky, Katrina Mattison, Greg Randolph. Using Quality Improvement Methods to Implement an Early Childhood Oral Health Initiative: A Federally Qualified Health Center Pilot Study. Journal of Clinical Pediatric Dentistry. 2017. 41(5);351-357.
1. Hunt RJ, Aravamudhan K. The quality movement in oral health care. Who will lead? J Am Dent Assoc;145:421-3. 2013.
2. Shrank, W. The Center For Medicare and Medicaid Innovation’s blueprint for rapid-cycle evaluation of new care and payment models. Health Aff (Project Hope);32(4), 807–12. 2013.
3. Berkowick DM, Nolan TW, Whittington J. The triple aim: care, health and cost. Health Aff (Milwood);27(3):759-69. 2008. 4. US Department of Health and Human Services. Quality Improvement, 2011. Available at: http://www.hrsa.gov/quality/toolbox/methodology/ qualityimprovement/index.html Accessed on: May, 2016.
5. Randolph GD, Bruckner J, See CH. Quality improvement in North Carolina’s public health departments. NC Med J ;74(2):137-41. 2013.
6. Bravata DM, Gienger AL, Holty, JC, Sundaram, V, Khazeni, N, Wise, PH, Owens, DK. Quality improvement strategies for children with asthma: a systematic review. Arch Pediatr Adolesc Med.;163(6):572–81. 2009.
7. Dilley, JA, Bekemeier, B, Harris, JR. Quality Improvement Interventions in Public Health Systems: A Systematic Review. Am J Prev Med;42(5, Supplement 1), S58–S71. 2012.
8. Munce, SE, Perrier, L, Tricco, AC, Straus, SE, Fehlings, MG, Kastner, M, Jaglal, SB. Impact of quality improvement strategies on the quality of life and well-being of individuals with spinal cord injury: a systematic review protocol. Syst Rev.2, 14. 2013.
9. Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Sundaram V, Rushakoff RJ, Owens DK. Effects of quality improvement strategies for type 2 diabetes on glycemic control: A meta-regression analysis. J Am Med Assoc;296(4),427–40. 2006.
10. Institute of Medicine. America’s Health in Transition: Protecting and Improving Quality. Washington, DC: The National Academies Press, 1994.
11. Bradshaw C, Goodman I, Rosenberg R, Bandera C, Fierman A. Rudy B. Implementation of an inpatient pediatric sepsis identification pathway. Pediatrics;137(3):1-8. 2016.
12. Goyal NK, Ammerman RT, Massie JA, Clark M, Van Ginkel JB. Using quality improvement to promote implementation and increase well child visits in home visiting. Child Abuse Negl;53:108-17. 2016.
13. Glassman P. Oral Health Quality Improvement in the Era of Accountability. W.K. Kellogg Foundation. 2011. Available at: http://www.dentaquestinstitute.org/sites/default/files/Oral%20Health%20Quality%20Improvement%20in%20an%20Era%20of%20Accountability%20December%20 2011%20Full%20Report.pdf Accessed on: May, 2016.
14. Ng MW, Ramos-Gomez F, Lieberman M, Lee JY, Scoville R, Hannon C, Maramaldi P. Disease management of early childhood caries: ECC collaborative project. Inter J Dent. 2014,2014:327801. doi 10.1155/2014/327801. Epub 2014 Mar 3.
15. Simpson DD. A Framework for Implementing Sustainable Oral Health Promotion Interventions. J Public Health Dent;71(s1), S84–S94. 2011.
16. Quinonez RB, Morris C, McCollum W, Wright TW, Kang J, Whitt K. Virtual Baby Oral Health Program Provider Website. University of North Carolina at Chapel Hill, 2013. Available at: www.babyoralhealthprogram. org Accessed on: June, 2017.
17. Cornett, A., Thomas, M., Davis, MV, Mahanna, E, Cordova, A, Herring, C, Randolph, GD. Early Evaluation Results From a Statewide Quality Improvement Training Program for Local Public Health Departments in North Carolina. J Public Health Manag Prac;18(1):43–51. 2012.
18. StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.
19. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the Twenty-first Century. Washington:National Academies Press, 2001.
20. See C. Personal communication based on unpublished data, MHA, April 21, 2014.
21. Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. J Am Med Assoc ;282:1458-65. 1999.
22. Pina IL, Bruckman D, Lance C, Hitch J, Gee J, Schaub K, Davidson M, Ober S, Aron D. Quality improvement in heart failure: A randomized educational intervention to change provider behavior. Congest Heart Fail ;18:242-53. 2012.
23. Randolph GD, Lea CS. Quality improvement in public health: Moving from knowing the path to walking the path. J Public Health Manag Prac;18(1):4-8. 2012.
24. Robert Wood Johnson Program Results Report. Evaluating quality improvement training programs: Do they increase the ability of people to successfully engage in work to improve health and health care? Grant ID:PQ1. 2013. Available at: http://www.rwjf.org/content/dam/farm/ reports/program_results_reports/2013/rwjf407570 Accessed on: June, 2017.
25. Davis MV, Cornett A, Mahanna E, See C, Randolph G. Advancing quality improvement in public health departments through a statewide training program. J Public Health Manag Pract ;22(2):E21-7. 2016.
26. Wright SS, Lea CS, Holloman R, Cornett A, Harrison LM, Randolph GD. Using quality improvement to promote breast-feeding in a local health department. J Public Health Manag Prac;18(1):36-42. 2012.
27. Ng MW, Torresyap G, White A, Melvin P, Graham D, Kane D, Scoville R, Ohiomoba H. Disease management of early childhood caries: results of a pilot quality improvement project. J Health Care Poor Underserved ;23 (3 Suppl):193-209. 2012.
28. Shi L, LeBrun-Harris LA, Daly CA, Sharma R, Sripipatana A, Hayashi AS, Ngo-Metzger Q. Reducing disparities in access to primary care and patient satisfaction with care: The role of health centers. J Health Care Poor Underserved;24:56–66. 2013.
29. Alexander JA, Hearld LR. The science of quality improvement implementation: developing capacity to make a difference. Medical Care:49 Suppl, S6–20. 2011.
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