P2.N279: Improving Fluoride Varnish Application Rates and Decreasing Disparities at an Urban FQHC.

Purpose/Objectives: Dental caries is the most common chronic disease of childhood. Fluoride varnish (FV) is effective and safe in preventing caries, and annual application is standard of care in pediatric primary care. In October 2022, only 27.7% of all empaneled primary care patients 6 months to 5 years had received FV in our clinic in the past year, and even fewer Black/African American (B/AA) patients (23.6%). Our aim was to improve clinic-wide FV rates by at least 10% per year, and to improve FV rates for B/AA patients by 10% or more each year in order to reduce disparities.

Design/Methods: In the fall of 2022, baseline data and clear goals were displayed on the clinic QI huddle board. A gap analysis revealed unclear responsibilities, convoluted ordering workflow, and suboptimal understanding of the importance FV. Our first intervention was to prominently display monthly rates and shout-out high performers each month. Monthly data on low performers was given to the nurse manager who would provide individualized coaching. In March 2023, the EMR process was streamlined, and ordering/dosing became completely MEA-driven. Clinic staff was educated on this workflow and received an in-service on oral health. Our clinic’s practice had been to apply FV only at Well Child Visits (WCV); to address persistent disparities, this policy was changed in January 2024 for B/AA patients, who are now eligible to receive FV at all visit types (WCV, Follow-Up, Lab, MEA); reminder notes were added to B/AA appointments. In addition, outreach calls to B/AA patients overdue for WCV began in October 2023 ( < 2 years) and was expanded in January 2024 ( < 6 years) as part of a separate clinic pilot that provides race concordant clinical care, and the outreach script specifically mentions the opportunity for FV.

Results: Steady improvement in FV application rates was noted from the outset (see Figure 1). The biggest jump was seen when MEA ownership was clarified and the EMR ordering process simplified (March 2023). However, disparities persisted and even worsened until Jan 2023 when specific resources were dedicated to B/AA patients. We are currently on track to achieve well over the 20% rate improvement we had hoped for, and our disparities have declined significantly.

Conclusion/Discussion: The success of our work to improve FV application rates was due to sustained attention, interdisciplinary collaboration and diverse interventions. Clear communication, education and positive reinforcement led to broad participation and support. Technical workflow changes clarified roles and reduced barriers and improved overall rates, but these changes proved inadequate to lessen disparities. Specific interventions were required to close the gap for B/AA patients. We plan to seek sustainable ways to ensure that all patients, and especially B/AA patients, receive FV at every clinical touchpoint.