Improving Oral Health in Rural Colorado

Commitment to Quality through Data-Informed Dental Care

Topic(s): Health Care Quality, Oral Health

Geographic Location: Lafayette, Colorado

Health Center: Clinica Campesina Family Health Services

Date Posted: September 16, 2019

Overview

Clinica Campesina Family Health Services Health Center (Clinica) strives to be the medical and dental care provider of choice for low income and other underserved people in the South Boulder, Broomfield, and West Adams counties of Colorado by using prevention focused approaches.

In 2018, of Clinica’s nearly 60,000 patients, almost 95% were at or below 200% the federal poverty guidelines, and 78% were of a racial or ethnic minority1.

Intervention

Children without dental sealants have almost three times the risk of cavities in their first molars than children with sealants. Sealants are shown to protect against 80% of cavities in children2 . Health centers that receive federal funding under HRSA’s Health Center Program are required to annually report the percent of children ages 6-9 years that received dental sealants in the Uniform Data System. 2014 to 2016, Clinica’s staff set a quality improvement (QI) goal to reduce caries at the next periodic exam, six months later, by 10%.

Their Vice President of Dental Services An Nguyen, DDS, MPH notes, “Why this 10% goal? When we started this QI project, we didn’t have a baseline measure, but we knew from the experience of working with our patients and examining their mouths, that decay rates were high, and we had a will to do something different to improve them.”

Two clinical interventions were key drivers to improving this outcome: increasing caries risk assessments to understand patient risk factors for decay and increasing the placement of sealants. Using Plan-Do-Study-Act cycles, a framework that enables small tests-of-change for improving real work settings, the health center implemented a caries risk assessment practice and established an evidence-based protocol for intervention based on patient risk level. To assist the team in implementing the protocol, a decision support tool was created which proactively alerts clinical team members about any gaps in care so they can be addressed in real time. This approach has allowed the health center to exceed their goal of reducing caries among their patients.

Impact

At the beginning of their QI project, 42% of their patients came back to the clinic with cavities but at the conclusion of their two year project, only 17% of their patients had decay after receiving care. This is more than a 50% decrease in cavities.

Clinica has been awarded HRSA Health Center Quality Improvement Awards  since 2013, demonstrating their ongoing commitment to improving the quality of health care delivered to Colorado communities. A commitment to quality can translate to improved internal processes, decision-making that is informed by data, and ultimately, better patient outcomes.


2018 Uniform Data System

School Sealant Programs,” Centers for Disease Control and Prevention, 2019 HRSA BPHC exit disclaimer

 

Date Last Reviewed:  September 2019