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Improvement Project Charter
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Project Title: Improving Oral Health Hygiene
among patients in Brookdale Family Care Center
(BFCC), New Lots Clinic
Team Members (if applicable):
University/Organization Name: Brookdale Hospital and Medical Center
What Are We Trying to Accomplish?
Problem
Dental caries is the most common chronic disease of childhood. Approximately 23% of children aged
2–11 years have at least one primary tooth with untreated decay. Fluoride varnish application has
been shown to decrease the incidence of dental caries by 43%.
Rationale
The American Academy of Pediatric Dentistry (AAPD) recommends fluoride varnish application every
3-6 months to all children regardless of oral health risk which should ideally be done in the setting of
the dental home. Data however shows that less than 30% of children enrolled in Medicaid programs
across the United States used dental services within the previous year. This places the general
pediatrician in a unique setting where he/she can provide the minimal basic dental care that a child
requires pending his/her establishment of a dental home.
Aim Statement
What outcome, in measureable terms, are you hoping to accomplish? Specify how good, for whom,
and by when — i.e., by what exact date:
Our aim is to increase the number of children less than 6 years old who receive fluoride
varnish application within the previous 6 months by 20% by June 30 2016
Expectations
Why have you chosen the aim you’ve set forth? Explain, in specific terms, what you believe will be the
beneficial outcomes of this project:
We believe that if we can implement our aims, the children served by our clinic will receive better
dental care. We expect to see a decreased incidence of dental caries and decreased morbidity among
our children. It will also translate into better patient satisfaction scores and will improve the
hospital’s oral health scores. Fluoride varnish application is reimbursable by Medicaid which will
translate to increased revenue for our clinic.
How Will We Know a Change Is an Improvement?*
Outcome (or Project) Measure(s)
List the measure(s) you ultimately want to affect:
1.
Number of children who receive fluoride varnish application within the previous 6 months
Process Measures
List the measures that will tell you if the parts or steps in the system are performing as planned to
affect the outcome measure:
1. Number of children who are screened for oral health risk using standardized assessment tools
2. Number of parents who are counseled about the benefits of fluoride varnish application
3. Number of fluoride varnish application kits available in the clinic
Balancing Measures
List the measures you will track to determine whether you are introducing problems in other parts of
the system:
Improvement Project Charter:
Faculty Assessment
1. Duration spent on each patient encounter
2. Patient and staff satisfaction
3. Expenditure and Revenue of clinic during project cycle
*In this section, provide operational definitions, which specify unambiguously how to derive
each measure. This means defining such characteristics as “accurate,” “complete,” or “timely” in
specific terms. If your measure is a percent or rate, specify the numerator (e.g., patient encounters
before which doctors and nurses washed hands) and the denominator (e.g., total patient encounters).
If it is an average, identify the calculation for deriving the average. If it is a score, such as a patient
satisfaction score, describe how to derive that score.
What Changes Can We Make to Improve?
Key Stakeholders
Whose input and support will this project require?
1.
Chairman, Ambulatory Care Centers for Brookdale Hospital
2. Primary Care Pediatricians (PCPs) at BFCC, New Lots Clinic
3. Nursing manager at BFCC, New Lots Clinic
How will you engage these key stakeholders?
1.
I will personally pitch my project idea to the stakeholders highlighting the benefits to the
patients and hospital
2. Request funds from the Chairman to purchase fluoride kits (I will provide him with a budget)
3. Educate primary care pediatricians on the skill of fluoride varnish application
Change Ideas
How will you learn more about the process or system you’re trying to improve? (e.g., interviews with
people within the process, cause and effect or driver diagrams, etc.)
1.
Fishbone diagram
What ideas do you have for initial tests of change (PDSA cycles)?
Plan: Get a baseline rate of children who have received fluoride varnish application in the past 6
months (This is currently 0% in our clinic)
Do: Educate patients using posters about the importance of oral hygiene and fluoride varnish
application
Purchase fluoride application kits
Educate PCPs on fluoride varnish application
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Apply fluoride varnish to the first patient
Study: Number of patients who have received the fluoride varnish application
Act: Modify changes based on my initial result and implement further changes including using EMR
to determine who is due for fluoride varnish application
Barriers
What are the barriers to the success of your project?
1. Finance 2. Lack of time on the part of the PCPs
How will you overcome the barriers you have listed?
1. Educate the stakeholders that implementing fluoride varnish application will improve revenue to
the clinic 2. Residents can be trained on how to apply fluoride varnish so PCPs have more time to see
patients
Improvement Project Charter:
Faculty Assessment
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Needs
Improvement
(1)
Meets
Expectations
(2)
Exceeds
Expectations
(3)
What Are We Trying to Accomplish?
Aim statement is clear and answers how good, for whom, and by when
x
Problem to be addressed clearly justifies need for improvement
x
Identifies aspect of care that will be improved and subsystems affected
x
The impact (positive and negative) on patients is clear
x
Supportive background information is provided
x
Specific objectives and numerical goals are clearly defined
x
Project can be completed within time frame
x
Addresses anticipated products, tools, and deliverables to be used
x
Feedback:
How Will We Know a Change Is an Improvement?
Identifies family of measures (at least 1 outcome, 2 process, 1 balancing)
x
Measures are directly related to project description, objectives, goals
x
Each measure is operationally defined in an appropriate way
Data collection is reasonable and practical given project scope
x
x
Feedback:
What Changes Can We Make to Improve?
Initial changes to be tested are clear and well defined
x
Specific methodology for selecting change is identified and explained
x
Project barriers are defined, including how both will be addressed
x
Identifies key stakeholders and explains their role in the process
x
Feedback:
All items must be satisfied in each domain at a rating of “2” or higher. Feedback should be provided for all items with
a score of “1,” and charter should be revised until expectations are met.
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