Questions 9-10: Example of a dental-related QI activity implemented during the past calendar year, and planned QI activity for new calendar year. Definition: Quality Improvement (QI) consists of systematic and continuous actions that lead to measureable improvement in health care services and the health status of targeted patient groups. Question 11: How clinic intends to use grant funds to improve patient dental outcomes. Scoring Rubric: Dental Assistance Request Section Applicant effectively described activities and/or efforts to integrate primary care and dental health services. (Question 1) Point Values: 1 = unsatisfactory 2 = satisfactory/meets criteria 3 = superior/exceeds criteria Applicant has effectively described a steady level of services provided and patients seen over the past three years. (Question 2) Point Values: 1 = not acceptable 2 = unsatisfactory 3 = satisfactory/meets criteria 4 = superior/slightly exceeds criteria 5 = exceptional/exceeds criteria Applicant effectively described patient education and health promotion efforts. (Question 3) Point Values: 1 = not acceptable 2 = unsatisfactory 3 = satisfactory/meets criteria 4 = superior/slightly exceeds criteria 5 = exceptional/exceeds criteria Applicant has effectively described outreach efforts. (Question 4) Point Values: 1 = unsatisfactory 2 = satisfactory/meets criteria 3 = superior/exceeds criteria Applicant has provided SMART Objective. (Question 5) Point Values: 1 = unsatisfactory 2 = satisfactory/meets criteria 3 = superior/exceeds criteria Applicant has reasonable/tangible objective(s) for the grant year and has effectively described the clinic’s planned activities to accomplish the objective(s). (Questions 5 and 6) Point Values: 1 = not acceptable 2 = unsatisfactory 3 = satisfactory/meets criteria 4 = superior/slightly exceeds criteria 5 = exceptional/exceeds criteria Applicant has effectively described how the clinic will measure progress on the activities listed above. (Question 7) Point Values: 1 = unsatisfactory 2 = satisfactory/meets criteria 3 = superior/exceeds criteria Applicant has effectively described how the clinic will measure progress on the activities listed above. (Question 8) Point Values: 1 = unsatisfactory 2 = satisfactory/meets criteria
3 = superior/exceeds criteria Applicant effectively described what quality improvement activity the clinic implemented this past year and described what quality improvement activities will be conducted in the next year. (Questions 9 & 10) Point Values: 1 = not acceptable 2 = unsatisfactory 3 = satisfactory/meets criteria 4 = superior/slightly exceeds criteria 5 = exceptional/exceeds criteria Applicant effectively described how the grant funds will be used to improve patient outcomes. (Question 11) Point Values: 1 = unsatisfactory 2 = satisfactory/meets criteria 3 = superior/exceeds criteria Section 5: Attachments The grant signature page is required for all applications. The FY2019 signature page can be found here: . All applicants are required to upload the documents requested in the attachments section. The documents are available for download on the webpage. Clinic Site Table – this form requests demographic information on all clinic’s in your organization. Operating Budget – This form requests total program revenue and expenses. In-Kind Contributions – This form is only applicable to applicants reporting donations to meet the 1:1 local match requirement. Community Engagement Examples – Please upload examples of your clinic’s community engagement projects. CONTACT INFORMATION Primary Care Office: Rubina Ranjit, Program Coordinator Cynthia Snyder, Director, Special Population Health, Primary Care and Rural Health Budgeting Technical Assistance Kevin Shaughnessy