AIM: Increase the # of San Francisco Medi-Cal Dental insurance member patients 0-5 years old seen in participating dental homes by 10% above baseline between 1/2019-12/2020. Methodology: The Model for Improvement strategy using Aim statements, Measurements, and Ideas for testing with serial Plan-Do-Study-Act cycles refined our evolving driver diagram and change package; all lovingly called Virtuous Learning Cycles by our improvement specialist. Measurements: Run Charts showing baseline # of patients with weekly access data over a series of sprints measured access to care. Ideas: Medi-Cal Dental providers strive to provide care to children, but need help learning how to do so. Collaboration with faculty team members allow crafting of continuous learning cycles in overlapping spheres such as QI method utilization, experiences of past participants of QI collaboratives, evidence-based preventive dental care and noninvasive caries management, cavity risk assessments, infant oral examination workflows, and motivational interviewing. Stakeholders at the table: -Medi-Cal Dental network Dental Providers. -Faculty team members-Irene Hilton, AFL Enterprises, Brandon Bennett, Ray Stewart, Peter Milgrom, Ramona English, An Nguyen, and Lyra Ng are the QI-minded Dentists, QI educators, collaborative facilitators, and content leaders on motivational interviewing in dentistry, evidence-based pediatric dentistry and a pediatrician for insight into child-centered primary care. What transpired? Parallel PDSA cycles—Participants and Collaborative: Access to care measurements: A total of 568 patients 0-5 years old were seen whom would not have otherwise been seen without SF DTI. -Learning cycles enhanced participant level change ideas leading to increased access to care in both pilot and cohort 1 sessions. -Aggregate data from Cohort 1 showed an increase in children seen by all teams until COVID-19 Shelter in Place (SIP) was implemented in the San Francisco Bay Area on 3/17/2020. Note the breadth of interventions studied. (1) Exciting real-time PDSAs at the Collaborative level: Organizational PDSAs on high-level programming allowed rapid pivoting on the process and delivery of Collaborative objectives. Working PDSAs show the importance of QI skills and methods in planning during COVID-19. -Ideas tested included synchronous video training of teams for Cohort 2 in lieu of in-person training due to COVID-19 SIP. PDSAs about system-wide shifts of preventive dentistry into the landscape of tele-dentistry. Active testing of workflows for synchronous video dentistry with real-time photos of children's teeth available for dental evaluation along with the use of home kits with toothbrush, toothpaste and Fluoride Varnish packets mailed home before visits show feasibility during COVID-19 SIP and beyond. On-going questions to test lie in the realm of coding, billing and receiving, electronic dental records, and video technology linking office providers to patients. (2)

Figure 1

Attachment 1. Aggregate run charts illustrate the breadth of change ideas incorporated in the collaborative. Overall program access to care data from Cohort 1.

Attachment 2: New process PDSA testing for Cohort 2.

Figure 1

Attachment 1. Aggregate run charts illustrate the breadth of change ideas incorporated in the collaborative. Overall program access to care data from Cohort 1.

Attachment 2: New process PDSA testing for Cohort 2.

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Figure 2

PDSAs driven by gaps in recruitment of participants for Cohort 2. PDSAs driven by impact of COVID-19 SIP on preventive dental care via tele-dentistry.

Figure 2

PDSAs driven by gaps in recruitment of participants for Cohort 2. PDSAs driven by impact of COVID-19 SIP on preventive dental care via tele-dentistry.

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