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

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 ???

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

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

Basis of Improvement Science:

Deming’s System of Profound Knowledge

Slide courtesy of Institute for Healthcare Improvement

Power of repeated small tests of change …

Slide courtesy of Institute for Healthcare Improvement from Improvement Guide, p. 103

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

What our QILC teams have learned and done in a short period of time is

truly remarkable and profound …

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

Thanks for your attention!

Questions?

Thanks to our partners & QILC Leadership! Support for this work provided by First 5 LA!