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  1. Christina Toth1,
  2. Suzanne Hoholik1,
  3. Mike Fetzer2,
  4. Rebecca Baum1,
  5. Stephen Cardamone3,
  6. Sean Gleeson1
  1. 1Nationwide Children's Hospital, Partners For Kids, United States
  2. 2Nationwide Children's Hospital, United States
  3. 3Partners For Kids, United States


Background Quality improvement (QI) practice facilitators (PFs) may help primary care providers (PCPs) improve care by adapting approaches to practice characteristics. Partners For Kids, an accountable care organization affiliated with Nationwide Children's Hospital (NCH), offers PFs to guide PCPs through QI projects to adopt clinical recommendations and improve patient outcomes. For example, one QI focus area is fluoride varnish (FV) application to prevent dental caries in young children, which was added to the American Academy of Pediatrics Periodicity Schedule for PCPs in 2015.

Objectives Practice-specific aims were created, for example, to “Increase the % of children <3 yrs with FV applications at well-child visits from 0% to 50% by 6/30/2017 and sustain through 12/31/2017”.

Methods From mid-2015 to mid-2016, 5 non-NCH-owned practices initiated FV QI projects with PFs and had at least 7 months follow-up. The PFs trained practices on the IHI Model for Improvement and led recurring, on-site meetings. Initial interventions included selecting products and training. Subsequent intervention themes included consent, visual reminders, and parent education. PFs shared successes among practices and hosted learning collaborative-style webinars. PFs regularly performed random audits of FV and aggregated practice data to evaluate program impact.

Results Use of FV increased from 0.0% to a median of 44.2% within 3 months with initial interventions. With subsequent interventions during months 4–7, performance increased further to 54.8%, and the center line shifted to 51.2%.

Conclusions Practices can benefit from assistance of PFs to effectively implement clinical recommendations.

Figure 1

Sample key driver diagram.

Figure 2

Fluoride Varnish application.

  • Accreditation
  • Anaesthesia
  • Attitudes

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