Multi-Level Interventions to Reduce Oral Health Disparities among Adults in Primary Care Settings

多层次干预措施减少初级保健机构成年人之间的口腔健康差异

• 批准号: 10441980
• 负责人: Suchitra S. Nelson
• 金额: $ 33.45万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-02 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10441980
• 关键词: Academy; Accounting; Address; Adoption; Adult; Affect; Aging; Attention; Behavior; Behavior Therapy; Behavioral; Belief; Biometry; Caring; Child Health; Cognitive; Collaborations; Community Practice; Data; Data Analyses; Data Collection; Dental; Dental Care; Dental Hygiene; Dental caries; Dentists; Diagnosis; Documentation; Education; Educational Curriculum; Elderly; Electronic Health Record; Enrollment; Equation; Health; Health system; Healthcare; Hospitalization; Informal Social Control; Intervention; Knowledge; Literature; Low income; Maintenance; Manuals; Measures; Mediation; Mediator of activation protein; Medicaid; Medical; Medical Care Costs; Medical Staff; Medicare; Medicine; Methods; Modeling; Mouth Diseases; Nurse Practitioners; Nurses; Ohio; Oral cavity; Oral health; Outcome; Outcomes Research; Paper; Pathway interactions; Patients; Perception; Periodontitis; Periodontium; Personal Satisfaction; Phase; Physicians; Physicians' Offices; Population; Primary Health Care; Procedures; Process; Process Measure; Professional Organizations; Protocols documentation; Provider; Publishing; Quality of life; Questionnaires; Randomized; Randomized Clinical Trials; Reach Effectiveness Adoption Implementation and Maintenance; Readiness; Recommendation; Reporting; Resources; Risk Assessment; Risk Factors; Sample Size; Sampling; Site; Source; Surveys; System; Systemic disease; Testing; Tooth Diseases; Tooth Loss; Tooth structure; Training; Training and Education; Trust; United States National Institutes of Health; Universities; Visit; Work; Writing; aged; arm; base; behavior change; behavior influence; behavioral/social science; burden of illness; care providers; collaborative care; design; education resources; efficacy testing; experience; health assessment; health care model; health disparity; implementation strategy; improved; innovation; intervention effect; novel; pilot test; prevent; primary care setting; primary outcome; quitline; recruit; secondary outcome; skills; skills training; smoking cessation; statistics; stem; systematic review; theories; web site; willingness

PROJECT SUMMARY/ABSTRACT Northeast Ohio has one of the highest rates of oral diseases (caries, periodontitis) and poor dental attendance among low-income older adults. Professional organizations and the IOM recommend integration of oral health (OH) activities into primary care for adults in order to reduce medical costs. But, published literature indicates a lack of outcomes data to assemble an effective medical-dental integration. Impeding integration are also factors such as lack of an electronic health record (EHR) based oral health (OH) assessment and referral, and inadequate OH education and training for medical providers. Our survey data indicate that the majority of providers would like OH facts to be communicated at primary care visits (PCV) but lack education and resources. There are misperceptions about oral diseases among older adults that prevent regular dental attendance. The proposed multi-level interventions will address factors that impede OH integration, and subsequently improve self-regulatory behaviors in adults. The interventions are: Practice (medical assistants, nurses): EHR systems based changes to ask, advise, assess, connect (AAAC). Provider (physician/nurse practitioner): improve knowledge and skills using Common-Sense Model of Self-Regulation (CSM) theory based education and skills training to communicate OH facts and reinforce importance of dental visits. A cluster-randomized clinical trial is proposed to test implementation (practice) and behavioral (provider) intervention to address self-regulation and increase dental attendance among low-income adults aged ≥55 years. The primary aims are: 1) UG3, Conduct qualitative work with stakeholders and practices; system-based changes in EHR; and pilot-test the interventions in 2 practices. UH3, randomize 8 practices to two arms to investigate the efficacy of a EHR based strategy at the practice level to ask [OH risk assessment], advise [going to dentist], assess [willingness for referral], connect [eReferral and/or resources] together with provider CSM theory-based education and skills to communicate OH facts versus provider alone (standard or usual oral health care) to increase dental attendance (primary outcome); and improve OH quality of life, oral hygiene behavior, and biometric measures of health (secondary outcomes). Secondary aims (UH3) are to explore: the delivery and documentation of AAAC implementation strategy; and to investigate causal pathways that affect the outcomes. The sample includes 209 providers and medical staff, and 800 Medicaid-enrolled adults. Data analysis (UG3) will utilize a mixed method design for qualitative and descriptive statistics for quantitative data. Data collection (UH3) will follow the RE-AIM framework: adults (outcome data from Medicaid claims, questionnaires, EHR); provider, practice (questionnaires); provider, practice (process measures: reach, fidelity, adoption, maintenance from audits). A generalized estimating equations approach will be used to assess effects of multi-level interventions on dental attendance and other outcomes, while accounting for clustering within practice. Mediation methods will determine if intervention effects occur through hypothesized mediators. A sustainable OH care model is proposed for primary care clinicians.

项目摘要/摘要 俄亥俄州东北部的口腔疾病率最高（龋齿，牙周炎）和牙齿差的差。 在低收入老年人中。专业组织和IOM建议口腔健康的整合 （OH）为了降低医疗费用的成人初级保健活动。但是，已发表的文献表明 缺乏结果数据来组装有效的医疗态度整合。阻碍整合也是因素 例如缺乏基于电子健康记录（EHR）的口腔健康（OH）评估和推荐，以及 为医疗提供者提供的OH教育和培训不足。我们的调查数据表明，大多数 提供者希望在初级保健访问（PCV）上传达OH事实，但缺乏教育和资源。 老年人的口腔疾病存在误解，以防止定期牙齿出席。这 拟议的多层次干预措施将解决阻碍OH集成的因素，并随后改善 成人的自我调节行为。干预措施是：实践（医疗助理，护士）：EHR系统 基于询问，建议，评估，连接的更改（AAAC）。提供者（医师/护士从业者）：改进 使用常识性自我调节模型（CSM）理论教育和技能的知识和技能 培训以传达OH事实并增强牙科访问的重要性。集群随机临床试验是 建议测试实施（实践）和行为（提供者）干预措施，以解决自我调节和 在年龄≥55岁的低收入成年人中增加牙齿出勤率。主要目的是：1）UG3，行为 利益相关者和实践的定性工作； EHR基于系统的变化；并试用干预措施 在两种实践中。 UH3，将8种实践随机分为两个武器，以调查基于EHR策略的效率 询问[OH风险评估]的实践水平，建议[去看牙医]，评估[愿意转诊]，连接 [偏爱和/或资源]与提供商基于CSM理论的教育和技能一起交流OH 单独的事实与提供者（标准或通常的口腔卫生保健）增加了牙齿出勤率（主要结果）； 并改善OH的生活质量，口腔卫生行为和健康的生物识别测量（次要结果）。 次要目的（UH3）将探索：AAAC实施策略的交付和文档；然后 研究影响结果的因果途径。样本包括209名提供者和医务人员，以及 800名医疗补助成年人。数据分析（UG3）将利用混合方法设计进行定性和 定量数据的描述性统计。数据收集（UH3）将遵循RE-AIM框架：成人 （Medicaid索赔，问卷，EHR的结果数据）；提供者，实践（问卷）；提供者， 实践（过程度量：触及，忠诚，采用，审计维护）。广义估计 方程方法将用于评估多层干预对牙齿出勤和其他的影响 结果，同时考虑练习中的聚类。调解方法将确定干预效果是否影响 为初级保健临床医生提出了可持续的OH护理模型。