Increasing Dental Varnish Rates in a Large Pediatric Care Network: A Quality Improvement Effort.

OBJECTIVE: The objective of this study was to increase dental varnish application rates across a large pediatric primary care network for all children, regardless of insurance type or race and ethnicity, using a quality improvement (QI) intervention.

METHODS: From July 2023 to October 2024, we implemented a multifaceted, iterative QI intervention that included electronic health record (EHR) prompts, practice-level education, maintenance of certification credit with monthly audit-and-feedback, and financial incentives. The primary outcome was the proportion of eligible preventive care visits (children aged 6 months to 5.99 years) at which dental varnish was applied. Balancing measures included application rates by insurance type and race and ethnicity. We evaluated implementation using Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework measures as follows: "Reach" (number of visits with varnish applied), "Effectiveness" (proportion of children receiving ≥1 varnish annually), "Adoption" (proportion of practices administering varnish), "Implementation" (visit-level application rate), and "Maintenance" (annual reimbursement, comparing July 2022 to June 2023 with July 2023 to June 2024).

RESULTS: During the intervention, 92 056 eligible preventive care visits occurred. Varnish application increased from 3.7% preintervention to 30.5%, exceeding our 20% target. RE-AIM findings included the following: Reach, application at more than 4000 visits per month (up from ∼400); Effectiveness, more than 50% of children received varnish annually (vs 25% at baseline); Adoption, increased from 6 to all 33 practices; Implementation, 30.5% application rate; and Maintenance, reimbursement increased from $155 000 to $416 000. Improvements were consistent across child insurance and race and ethnicity.

CONCLUSIONS: A system-wide, EHR-enabled QI intervention significantly improved dental varnish application for all children, regardless of insurance type or race and ethnicity. This approach may serve as a scalable model for integrating dental varnish into pediatric primary care.