integrating oral health care systems using qi: reflections on qi … · 2015. 12. 2. ·...
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Integrating Oral Health Care Systems using QI:
Reflections on QI Learning Collaboratives
Jim Crall, DDS, ScD Project Director & QILC Chair, UCLA-First 5 LA Oral Health Program
Professor & Chair, UCLA Public Health & Community Dentistry
2015 NNOHA Conference
Indianapolis, IN November 17, 2015
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Context for this work . . . Systems ….. (and houses divided)
• 20 busy FQHC dental practices with general dentists largely treating adults
• 20 busy primary care practices providing care for large #’s of young children – 10,000 more 0-5 year olds receiving primary care
services than receiving dental services in 12 CHCs
• Co-located medical and dental services, but little to no history of working together.
• Will √ …… Ideas √ ...... Execution ???
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Applying improvement science to achieve systems change
It is not enough to know, we must apply. – Goethe
“Every system is perfectly designed to get the results it gets.” -- Dr. Paul Batalden
•10,000 more 0-5 year olds receiving medical services in DHP clinics than receiving dental care
Children presenting with advanced needs and clinics’ service delivery capacity
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Or to put it in layman’s terms ….
“If you always do what you always did, you will always get what you always got.” --Moms Mabley
•10,000 more 0-5 year olds receiving medical services in DHP clinics than receiving dental care
Children presenting with advanced needs and clinics’ service delivery capacity
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Basis of Improvement Science:
Deming’s System of Profound Knowledge
Slide courtesy of Institute for Healthcare Improvement
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Power of repeated small tests of change …
Slide courtesy of Institute for Healthcare Improvement from Improvement Guide, p. 103
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Value of QI Learning Collaboratives
• Transparency about processes and outcomes • Sharing information, data, tools and resources
with other teams participating in the collaborative • Receiving and seeking coaching and technical
assistance from clinical faculty • Appreciation of the value of teams • All teach, all learn …. formation of learning
organizations and learning communities • Dental personnel and operations integrated
into health center leadership and programs
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What our QILC teams have learned and done in a short period of time is
truly remarkable and profound …
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J. Crall - MA AAPD DHI State
The age at the first preventive dental visit had a significant positive effect on service use and dentally related expenditures.
• 1st dental visit / Total cost: – Before age 1 $262
– Age 1-2 $339
– Age 2-3 $449
– Age 3-4 $492
– Age 4-5 $546
Our path to the Triple Aim
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Thanks for your attention!
Questions?
Thanks to our partners & QILC Leadership! Support for this work provided by First 5 LA!