Background 28% of US children aged 2 to 5 years old have early childhood caries (ECC), a disease that is largely preventable if children receive early and consistent oral health interventions. Yet, strategies ensuring timely delivery of these services remain unclear.
Objectives To describe efforts in two primary care centers to increase rates of oral health education (OHE) and fluoride varnish (FV) applications during well-child visits.
Methods In accordance with American Academy of Pediatrics Guidelines (released September 2015), we implemented universal OHE and FV applications in children under 5 years of age. Nurses entered patient caries risk assessment responses into electronic medical records (EMR). The frequency of FV applications and billing were assessed through monthly automated EMR data extraction. Key PDSA intervention cycles included implementation of nursing-driven protocols to allow independent abbreviated OHE and FV applications, daily automated data reports on completed and eligible OHE and FV, reminder signage and email newsletters, in-person communications, and redesign of the billing sheet layout.
Results Over a 20 month period, in Center 1, FV orders increased from 57% to 80% and FV billing increased from 10% to 70%, while OHE was largely maintained above the target of 80%. In Center 2, FV orders and billing increased from 42% to 67% and 10% to 36% respectively, while OHE currently averages 59%.
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