Removing Barriers to Fluoride Varnish Application in Primary Care Settings

消除初级保健环境中使用含氟清漆的障碍 项目摘要/摘要： 龋齿是一个重要的、持续的公共卫生问题，它会影响来自 低收入家庭和来自种族和族裔少数群体的比率高于一般 人口。因为年幼的孩子更有可能去看初级保健提供者，而不是 牙医，包括儿科适当和有效的预防性口腔健康服务(POHS) 儿童探视有可能极大地改善儿童的口腔健康。含氟清漆 (FV)申请是这样一种由小学保险计划报销的POH 为年幼的儿童提供护理环境，但只有一小部分医生应用FV。这个 该项目的目标是评估和减少目前阻碍初级保健医生 在健康儿童探视期间提供FV。 第一个目标是收集和分析有关时间、成本和工作流程的详细数据 与初级保健环境中的FV分娩相关。实现这一目标的关键组件将 包括对来自具有各种实践合作诊所的数据进行时间研究和瓶颈分析 特点。第二个目标是评估POHs交付的障碍和促进者 初级保健设置。将综合框架应用于实施研究 (CFIR)收集和分析来自关键线人访谈的数据、利益相关者的 将对干预气候的观点进行分析，以更好地理解其基本原理 潜在的POHs交付的明显障碍，重点是消除工艺流程障碍。 最终目标是优化FV在健康儿童访问工作流程中的应用。统计分析， 模拟和数学建模将被用来确定如何最大限度地减少时间和 不同环境因素组合的变异性影响下的成本。最好的 将整理和传播执行的做法。而FV应用程序则不 独立于其他活动运行，这些模型还可以帮助确定 报销将为增加FV应用程序提供额外资源，而不会牺牲其他 预防性护理。 研究的贡献将是具体的工作流程建议和结果资源 和成本数据，以及更好地了解实施的障碍和促进者， 这将允许医生办公室就如何将FV整合到他们的儿科健康中做出决定- 孩子们根据自己独特的实践特点进行参观。这些改进的框架， 广泛传播，将有助于在健康儿童探视期间更广泛地提供POH。

Removing Barriers to Fluoride Varnish Application in Primary Care Settings Project Summary/Abstract: Dental decay is an important, ongoing public health concern that impacts children from low-income households and from racial and ethnic minorities at higher rates than the general population. Because young children are much more likely to visit a primary care provider than a dentist, including appropriate and effective preventive oral health services (POHS) at pediatric well-child visits has the potential to dramatically improve children’s oral health. Fluoride varnish (FV) application is one such POHS that is reimbursed by insurance programs in the primary care setting for younger children, yet only a small proportion of physicians apply FV. The objective of this project is to assess and reduce barriers currently dissuading PCPs from providing FV during well-child visits. The first aim is to collect and analyze detailed data on time, costs and workflow associated with FV delivery in primary care settings. Key components to achieve this aim will include time study and bottleneck analysis of data from partner clinics with a variety of practice characteristics. The second aim is to assess barriers and facilitators to POHS delivery in primary care settings. Applying the Consolidated Framework for Implementation Research (CFIR) to the collection and analysis of data from key informant interviews, stakeholders’ perspectives on intervention climates will be analyzed to better understand the rationale underlying apparent barriers to POHS delivery, with a focus on process flow barrier elimination. The final aim is to optimize FV application in the well-child visit workflow. Statistical analysis, simulation, and mathematical modeling will be utilized to establish how to minimize time and costs under the influence of variability for different combinations of environmental factors. Best practices for implementation will be collated and disseminated. While FV application does not operate in isolation of other activities, these models can also help determine whether reimbursements would fund additional resources to add FV application without sacrificing other preventive care. The research contribution will be specific workflow suggestions and resulting resource and cost data, as well as a better understanding of barriers and facilitators to implementation, that will allow physicians’ offices to make decisions on how to integrate FV in their pediatric well- child visits based on their own unique practice characteristics. These improved frameworks, widely disseminated, will faciliate more widespread delivery of POHS during well-child visits.