Using Quality Improvement Methods to Implement an Early Childhood Oral Health Initiative: A Federally Qualified Health Center Pilot Study

Abstract

Objectives: 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.