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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Pregnancy.

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Strategy. Quality Improvement Collaboratives (Pregnancy)

Approach. Implement quality-improvement collaboratives in safety net dental clinics to increase access to oral health care for expectant parents

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Overview. Research indicates that challenges to accessing oral health care for expectant parents with low incomes who frequently receive care in safety net settings such as health departments and community health centers are greater than for expectant parents with higher incomes.[1, 2] Safety net dental settings offer free or reduced-cost care to people with low incomes. Implementing a quality-improvement collaborative in a safety net dental clinic can improve access to oral health care for expectant parents.[3] Quality improvement collaboratives bring together teams from multiple sites to share best practices, identify system-level challenges, and implement data-driven changes that enhance service delivery. These collaboratives can address workflow issues, improve appointment scheduling, strengthen care coordination between prenatal and dental providers, and create standardized protocols that ensure pregnant individuals receive timely preventive dental services regardless of their ability to pay.

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Collaborative participation and engagement metrics
  • Data on QI interventions
  • Qualitative feedback from participating clinics

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of safety net dental clinics participating in quality improvement (QI) collaboratives focused on expectant parents. (Measures engagement in QI initiative among dental clinics serving the population of focus)
  • Number of expectant parents reached through outreach and education by participating clinics. (Measures efforts to increase awareness of and access to oral health services)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of participating clinic staff who complete training on providing care to expectant parents. (Measures level of knowledge on workforce competencies)
  • Percent of QI projects in participating clinics that use real-time data to drive rapid-cycle improvements. (Measures breadth of data-driven quality improvement projects that translate to internal activities)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of referral partnerships established between participating dental clinics and prenatal care providers. (Measures care coordination across dental and healthcare infrastructure)
  • Number of participating clinics that integrate oral health prompts and reminders into their electronic health record systems. (Measures level of integration of tech-enabled service delivery into clinic tech operations)
  • Number of expectant parents in participating clinics who establish a dental home and receive regular care. (Measures continuity of care across medical and dental clinics)
  • Number of babies born to expectant parents in participating clinics who receive early preventive oral health services. (Measures intergenerational impact)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of participating clinics that integrate oral health prompts and reminders into their electronic health record systems. (Measures level of integration of tech-enabled service delivery into clinic tech operations)
  • Percent of participating clinics that collect and stratify oral health access and outcome data by key factors. (Measures level of specificity in data collection and analysis practices)
  • Percent reduction in oral health access gaps between expectant parents at participating vs. non-participating clinics. (Measures impact of QI initiative)
  • Percent of expectant parents from various communities who achieve oral health stability and retention in care at participating clinics. (Measures outcomes for populations of focus)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Association of State and Territorial Dental Directors, Best Practice Committee. 2019. Best Practice Approach: Perinatal Oral Health. Reno, NV: Association of State and Territorial Dental Directors.

2 Association of State and Territorial Dental Directors. 2020. Perinatal Oral Health Policy Statement. Reno, NV: Association of State and Territorial Dental Directors.

3 Vander Schaaf EB, Quinonez RB, Cornett AC, Randolph GD, Boggess K, Flower KB. 2018. A pilot quality improvement collaborative to improve safety net dental access for expectant parents and young children. Maternal and Child Health Journal 22(2):255–263.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.