Department of General Academic Pediatrics, Children's Mercy Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
Department of General Academic Pediatrics, Children's Mercy Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Pediatrics. 2018 Jun;141(6). doi: 10.1542/peds.2017-2396.
The American Academy of Pediatrics recommends periodic oral health risk assessments (OHRAs) for young children to prevent early childhood caries and promote oral health. The objective of this quality improvement project was to incorporate OHRAs, including documentation of the oral screening examination, into well-child visits for patients aged 12 to 47 months to drive (1) improved rates of preventive fluoride varnish (FV) application and (2) improved dental referrals for children at high risk for caries.
We identified a quality gap in our OHRAs, oral examination completion, FV application rates, and dental referral rates via retrospective data collection. Plan-Do-Study-Act cycles targeted modification of electronic medical record templates, oral health education, and standardization of work processes. Process and outcome measures were analyzed with statistical process control charts.
At baseline, OHRAs and oral screening examinations were documented in <2% of patients. Of eligible children, 42% had FV applied. Routine dental referrals before age 3 years were uncommon. After multiple Plan-Do-Study-Act cycles, documentation of OHRAs and oral screening examinations (process measures) improved to 45% and 73%, respectively. The primary outcome measure, FV rates, improved to 86%. Referral of high-risk patients to a dentist improved to 54%.
A systematic, evidence-based approach to improving oral health, including electronic medical record-based interventions, resulted in improved documentation of oral health risks and oral screening, improved rates of FV application in young children, and increased identification and referral of high-risk patients.
美国儿科学会建议对幼儿进行定期口腔健康风险评估（OHRA），以预防幼儿龋齿并促进口腔健康。本质量改进项目的目的是将 OHRA 纳入 12 至 47 个月龄儿童的常规儿童保健就诊中，以（1）提高预防性氟化物涂料（FV）应用率，（2）提高有患龋高风险儿童的口腔转诊率。
我们通过回顾性数据收集，发现了我们在 OHRA、口腔检查完成情况、FV 应用率和口腔转诊率方面存在质量差距。计划-执行-研究-行动循环旨在修改电子病历模板、进行口腔健康教育以及标准化工作流程。采用统计过程控制图分析过程和结果指标。
在基线时，OHRA 和口腔筛查检查的记录率<2%。在符合条件的儿童中，42%的儿童应用了 FV。在 3 岁之前常规进行口腔转诊的情况并不常见。经过多次计划-执行-研究-行动循环，OHRA 和口腔筛查检查的记录率（过程指标）分别提高到 45%和 73%。主要结果指标 FV 应用率提高到 86%。高危患者转诊至牙医的比例提高到 54%。
一种系统的、基于证据的口腔健康改善方法，包括基于电子病历的干预措施，可提高口腔健康风险和口腔筛查的记录率，提高幼儿 FV 应用率，并增加高危患者的识别和转诊。
