No-Show Prevention Practices in Dental Care Settings Serving Underserved Populations

为服务不足人群提供牙科护理机构中的缺席预防实践

• 批准号: 10367495
• 负责人: Todd David Molfenter
• 金额: $ 33.74万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10367495
• 关键词: Address; Admission activity; Affect; Appointment; Appointments and Schedules; Caring; Clinic; Clinical; Clinical Data; Clinical Trials; Cluster randomized trial; Communities; Dental; Dental Care; Dental Clinics; Engineering; Ensure; Ethnic Origin; Evidence based practice; Goals; Health; Health Services; Health Services Accessibility; Healthcare; Hour; Intervention; Intervention Studies; Manuals; Mediating; Medical; Methods; Modeling; Operative Surgical Procedures; Oral health; Organizational Change; Patient Appointment; Patients; Performance; Pilot Projects; Prevention; Process; Protocols documentation; Quality of Care; Race; Randomized; Reduce health disparities; Reporting; Research; Research Design; Research Personnel; Resources; Role; Schedule; School Dentistry; Services; Site; Standardization; Structure; System; Team Process; Techniques; Testing; Time; Underserved Population; United States; Universities; Visit; Wisconsin; base; care delivery; college; data quality; design; effectiveness testing; efficacy implementation trial; evidence base; experience; health care service organization; health care settings; health disparity; implementation facilitation; improved; innovation; motivational enhancement therapy; operation; organizational readiness; patient population; recruit; service organization; tool; treatment as usual; virtual visit

Project Summary/Abstract Dental settings have been plagued with persistent no-show rates that are associated with low quality of care, inadequate care access, and inefficient use of organizational resources for the patients and organizations that need them most. Patient appointment no-shows are particularly pronounced in organizations that service underserved populations. Studies documenting strategies to reduce no-shows in dental settings are limited, with organizations reporting difficulty in replicating the findings, particularly in diverse patient populations. In this study, a team of researchers from the Marquette University School of Dentistry and the Center for Health Enhancement Systems Studies (the Center) at the University of Wisconsin–Madison College of Engineering will test the effectiveness of three no-show reduction strategies using an innovative full factorial design that allows for the simultaneous testing of different combinations of the no-show strategies. The intervention strategies include a) using Motivational Interviewing techniques when scheduling appointments, b) conducting reminder calls 24 and 48 hours before an appointment, and c) applying open-access scheduling, along with other practices found to reduce no-shows in other sectors of health. The practices to test emerged from a pilot conducted by the study team with dental clinics that primarily serve underserved populations. A significant aspect of this study is the use of the NIATx Organizational Change Model (the NIATx model) to facilitate and provide a standardized evidence-based strategy for no-show practice implementation and to address the concern of the inability to apply proven no-show strategies. The UG3 will require a full two years to finalize the study protocol and operations manual and formalize partnerships with 40 dental clinics. The UH3 will test if different combinations of the no-show strategies of Motivational Interviewing, reminder calls, and scheduling practices can improve no-show rates compared to treatment as usual (Aim 1). A mediational analysis will examine whether using the NIATx model with fidelity and Organizational Readiness for Change mediates no- show rates (Aim 2). The qualitative portion of the study will aid in interpretation of quantitative results and will be used to gain a more in-depth understanding of the factors that promote or impede the implementation of the no-show strategies (Aim 3). This trial will be among the first RCTs to test a combination of no-show strategies in health care that is focused on the underserved populations where no-shows are most pronounced and have the greatest adverse clinical consequences. The investigative team has successfully conducted a pilot study on this subject and has considerable experience with large clinical trials. In summary, the study intends to provide an evidence-based replicable approach to reduce no-show rates, with the goal of helping the dental care field make organizational changes that support evidence-based care and improve care access.

项目概要/摘要 牙科环境一直受到与护理质量低下相关的持续缺席率的困扰， 患者和组织的护理机会不足，组织资源利用效率低下 在提供服务的组织中，患者预约缺席的情况尤其明显。 服务不足的人群减少牙科诊所缺席的研究记录策略有限， 一些组织报告说很难复制这些发现，特别是在不同的患者群体中。 这项研究由来自马凯特大学牙科学院和健康中心的研究人员团队进行 威斯康星大学麦迪逊工程学院增强系统研究（中心） 将使用创新的全因子设计来测试三种减少缺席率策略的有效性 允许同时测试未出现策略的不同组合。 策略包括 a) 在安排预约时使用动机访谈技术，b) 进行 在预约前 24 和 48 小时拨打提醒电话，以及 c) 应用开放访问日程安排，以及 其他卫生部门发现可以减少缺席的做法 测试的做法来自于试点。 由主要服务于服务不足人群的牙科诊所的研究小组进行。 本研究的一个方面是使用 NIATx 组织变革模型（NIATx 模型）来促进和 为缺席实践的实施提供标准化的循证策略，并解决 由于无法应用行之有效的缺席策略，UG3 需要整整两年的时间才能最终确定。 UH3 将研究协议和操作手册并与 40 家牙科诊所正式建立合作伙伴关系。 动机访谈、提醒电话和日程安排的缺席策略的不同组合 与常规治疗相比，这种做法可以提高缺席率（目标 1）。 检查使用具有保真度和组织变革准备度的 NIATx 模型是否会调解不- 显示比率（目标 2）。研究的定性部分将有助于解释定量结果。 用于更深入地了解促进或阻碍实施的因素 缺席策略（目标 3） 该试验将是测试缺席策略组合的首批随机对照试验之一。 医疗保健领域的重点是服务不足的人群，这些人群的缺席现象最为明显，并且 研究小组已成功进行了一项试点研究。 对此主题并具有丰富的大型临床试验经验总而言之，该研究旨在 提供基于证据的可复制方法来降低缺席率，目标是帮助牙科 护理领域进行组织变革，支持循证护理并改善护理服务。