Oral Health Equity in Alaska (OHEAL): Implementation and Evaluation of Delivery System Changes to Reduce Oral Health Disparities for Native American Children

阿拉斯加口腔健康公平 (OHEAL)：实施和评估交付系统变革以减少美洲原住民儿童的口腔健康差异

• 批准号: 8984140
• 负责人: Joana Cunha-Cruz
• 金额: $ 54.99万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-18 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8984140
• 关键词: Adoption; Affect; Alaska; Ally; American Indian and Alaska Native; Caring; Case Management; Child; Childhood; Clinic; Collaborations; Communities; Controlled Study; Dental; Dental Care; Dental Care Delivery; Dental Offices; Dental Staff; Dental caries; Dentists; Educational Intervention; Evaluation; Evidence based intervention; Evidence based practice; Family; Fluorides; Focus Groups; Goals; Health; Health Services Accessibility; Health Surveys; Healthcare; Healthcare Systems; Human Resources; Indigenous; Individual; Information Systems; Intervention; Interview; Life; Manuals; Methods; Modeling; Monitor; Native Americans; Oral health; Outcome; Pacific Northwest; Patient Self-Report; Patients; Phase; Pit and Fissure Sealants; Population; Preventive; Primary Health Care; Process; Protocols documentation; Provider; Research; Research Institute; Resources; Risk; Risk Assessment; Scanning; Series; Solutions; Staging; Supervision; Surveys; System; Testing; Time; Training; Universities; Washington; antimicrobial; base; care systems; community based participatory research; community living; community organizations; community setting; cost; design; evidence base; experience; follow-up; health disparity; health equity; improved; innovation; interest; operation; prevent; programs; public health relevance; racial and ethnic; racial and ethnic disparities; racial disparity; resilience; routine care; screening; social; tribal Nation

 DESCRIPTION (provided by applicant): American Indian and Alaska Native (AIAN) children are particularly affected by disparities in oral health: AIAN children have double the caries experience of white children and 2 to 3 times higher rates of untreated caries. Despite great resilience in tribal nations, geographical isolation, dentist shortages, and community mistrust on health care systems exacerbate the inequity. In Alaska, Dental Health Aides, drawn from indigenous communities, are available to provide preventive and interim care and to serve as patient navigators so that children receive curative care. Disparities could be reduced if the dental care delivery system, including the community-based allied dental personnel, were more effective. However, no studies have yet evaluated the incorporation of evidence-based dental treatments into routine care delivered by a dental team as part of a comprehensive program to eliminate racial disparities in pediatric oral health. The proposed research (Oral Health Equity for Alaska, OHEAL) seeks to bridge the gap between research and practice by conducting a multi-level phase IV implementation study at the community, organization, provider, family and individual levels. The goal is to build on the existing system to design, implement and evaluate a series of dental care delivery system changes. The population of interest is 7,000 children, 2500 AIAN, living in communities served by the South East Alaska Regional Health Consortium (SEARHC). The intervention will result in a culturally competent, population-, risk- and evidence-based dental care delivery system. Case management, screening, risk assessment, preventive and caries arrest treatments will be delivered by Primary Dental Health Aides (PDHA) in alternative community settings, with seamless and timely referrals to Dental Health Aides Therapists (DHAT), as well as pediatric and primary care dentists at dental offices. Following the stages of the Active Implementation Framework, the study will use community-based participatory research with mixed-methods (interviews, focus groups, surveys and before and after controlled study). The specific aims are to (1) conduct a needs and capacity assessment of the communities and the dental care organization; (2) develop Native-specific culturally-appropriate processes and materials for the OHEAL implementation and (3) reinforce stakeholder support during UH2; (4) install; (5) implement; and (6) evaluate the OHEAL model in relation to adoption, fidelity, costs and impact on oral health, access and quality of dental care, racial/ethnic equity in oral health and racial/ethnic equity in dental care access and qualit during UH3. By tailoring evidence-based practices to the cultural and social reality of the AIAN children and the communities they live, SEARHC will be more efficient in improving the oral health of the communities and contribute to the reduction of racial disparities in oral health of children. This project is collaboration among University of Washington (UW) Pacific Northwest/Alaska Center to Reduce Oral Health Disparities, UW Indigenous Wellness Research Institute, UW Partnerships for Native Health, DENTEX, and SEARHC.

 描述（由申请人提供）：美国印第安人和阿拉斯加原住民 (AIAN) 儿童尤其受到口腔健康差异的影响：AIAN 儿童的龋齿经历是白人儿童的两倍，未经治疗的龋齿率高出 2 至 3 倍，尽管他们的口腔健康恢复能力很强。部落民族、地理隔离、牙医短缺以及社区对医疗保健系统的不信任加剧了阿拉斯加的不平等，来自土著社区的牙科保健援助可用于提供预防性和临时护理并为患者提供服务。如果牙科护理服务系统（包括基于社区的联合牙科人员）更加有效，则可以减少儿童接受治疗的差异。但是，尚未有研究评估将循证牙科治疗纳入常规护理。该研究由牙科团队提供，是消除儿科口腔健康种族差异综合计划的一部分。拟议的研究（阿拉斯加口腔健康公平，OHEAL）旨在通过进行多层次的第四阶段实施来缩小研究与实践之间的差距。在社区学习，目标是在现有系统的基础上设计、实施和评估一系列牙科护理服务提供系统的变革。感兴趣的社区人口为 7,000 名儿童，2500 名 AIAN，他们居住在该系统中。东南阿拉斯加地区健康联盟 (SEARHC) 将通过该干预措施建立一个具有文化能力、基于人口、风险和证据的牙科护理服务系统。基本的在积极实施框架的各个阶段之后，该研究将使用替代社区环境中的牙科健康助手 (PDHA)，无缝及时地转介给牙科健康助手治疗师 (DHAT) 以及牙科诊所的儿科和初级保健牙医。基于社区的参与性研究，采用混合方法（访谈、焦点小组、调查和前后对照研究），具体目标是 (1) 对社区和牙科护理组织进行需求和能力评估；发展针对 OHEAL 实施的适合当地文化的流程和材料，以及 (3) 在 UH2 期间加强利益相关者的支持；(5) 实施；以及 (6) 评估 OHEAL 模型的采用、保真度、成本和通过根据 AIAN 儿童的文化和社会现实调整基于证据的实践，对 UH3 期间口腔健康、牙科护理的获取和质量、口腔健康的种族/民族公平以及牙科护理获取和质量的种族/民族公平产生影响。 SEARHC 将更有效地改善社区的口腔健康，并为减少儿童口腔健康方面的种族差异做出贡献。该项目是华盛顿大学 (UW) 太平洋西北/阿拉斯加中心的合作项目。减少口腔健康差异、华盛顿大学土著健康研究所、华盛顿大学土著健康合作伙伴关系、DENTEX 和 SEARHC。