P0794 - Improving Oral Health Risk Factor Assessment in a Private Practice Setting – a Preventative Care Quality Improvement Project

Title
Improving Oral Health Risk Factor Assessment in a Private Practice Setting – a Preventative Care Quality Improvement Project

Authors
Andrew Lee, DO, Ayesha Mirza, MD, Randolph Thornton, MD

Background and Objective
The American Academy of Pediatrics (AAP) recommends fluoride varnish in the primary care setting every 3-6 months starting at tooth emergence, as an important component to preventing dental caries in children. Only 4.3% of nondental healthcare providers, however, incorporate oral preventative services into their routine well-child checks (WCC). Our SMART AIM was three-fold: 1. Increase the percentage of fluoride treatment in a busy urban private practice setting (21,000 patient visits/year) from 4% in September 2019 to 25% by March 2020. 2. Decrease the percentage of continual sippy cup use from 37% in September 2019 to 15% by March 2020. 3. Decrease the percentage of frequent snacking from 70% in September 2019 to 50% by March 2020.

Methods
We designed and implemented an oral health care (OHC) protocol for children coming to their WCC (6 months to 5 years of age) that consisted of: a. anticipatory guidance handouts displayed in the main waiting room area and given to families during their WCC; b. administration of the AAP Pediatric Oral Health Risk Assessment Tool (POHRAT) at every WCC; c. the application of fluoride varnish. Our primary outcome was the percentage of fluoride varnish treatments, calculated as the number of treatments divided by the number of WCC that were coded per month. Secondary outcomes included decreased continual sippy cup use and snacking. Analysis for oral health risk factors was done using the POHRAT, while the electronic health records were used for analyzing the uptake of fluoride treatments.

Results
Using multiple PDSA cycles, the percentage of fluoride treatments increased from 4% to 15%, and the rates of frequent snacking decreased from 70% to 42% over a 6-month period (Fig. 1,2). However, the rates of continual sippy cup use increased from 37% to 42%.

Conclusion
Our OHC efforts improved utilization of fluoride varnish treatment, and rates of frequent snacking in a private practice setting. Most importantly, by providing more oral health anticipatory guidance, we were able to raise awareness and implement a systematic approach to increasing fluoride varnish treatment rates along with patient education. There was a small increase in the rate of continual sippy cup use, but we attribute this to social and cultural influences that make sippy cup use more favorable and convenient. We plan to make the ongoing OHC initiatives an integral part of our practice. Pediatric offices can play a crucial role in improving OHC by offering ongoing anticipatory guidance and fluoride varnish treatments with every WCC.