Increasing Dental Varnish Rates in a Large Pediatric Care Network: A Quality Improvement Effort

Area of Science:

• Pediatric Primary Care
• Public Health
• Quality Improvement Science

Background:

• Dental caries is a significant public health issue affecting young children.
• Early application of dental varnish is a proven preventive measure against caries.
• Disparities exist in dental varnish application rates based on insurance and race/ethnicity.

Purpose of the Study:

• To increase dental varnish application rates in a large pediatric primary care network.
• To ensure equitable application across all children, irrespective of insurance or socio-demographic factors.
• To implement and evaluate a quality improvement (QI) intervention for dental varnish delivery.

Main Methods:

• A multifaceted, iterative QI intervention was implemented from July 2023 to October 2024.
• Intervention components included EHR prompts, practice education, maintenance of certification credit, and financial incentives.
• The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided evaluation.

Main Results:

• Dental varnish application increased from 3.7% to 30.5%, surpassing the 20% target.
• Improvements were consistent across different insurance types and racial/ethnic groups.
• Key RE-AIM metrics showed significant increases in reach, effectiveness, adoption, implementation, and maintenance.

Conclusions:

• A system-wide, EHR-enabled QI intervention effectively improved dental varnish application rates.
• The intervention demonstrated scalability and potential for widespread integration of dental care into pediatric settings.
• Equitable improvements across diverse populations highlight the intervention's success in reducing disparities.