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

基本信息

批准号：
10633139
负责人：
Suchitra S. Nelson
金额：
$ 32.23万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
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/10633139
关键词：
Academy Address Adoption Adult Affect Aging Attention Behavior Behavior Therapy Behavioral Belief Biometry Caring Child Health Cognitive Collaborations Communication Community Practice Data Data Analyses Data Collection Dental Dental Care Dental Hygiene Dental caries Dentists Diagnosis Documentation Education Educational Curriculum Elderly Electronic Health Record Electronics Enrollment Equation Exclusion Health Health education Health system Healthcare Hospitalization Informal Social Control Intervention Knowledge Literature Low income Maintenance Manuals Measures Mediation Mediator Medicaid Medicaid eligibility 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 Personal Satisfaction Phase Physicians Physicians&apos Offices Population Primary Care Printing Procedures Process Process Measure Professional Organizations Protocols documentation Provider Publishing Quality of life Questionnaires Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Readiness Recommendation Reporting Resources Risk Assessment Risk Factors Sample Size Sampling Site Source Structure 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 behavior change behavior influence behavioral and social science burden of illness design efficacy testing electronic health record system experience health assessment health care model health disparity health training implementation strategy improved innovation intervention effect novel oral communication pilot test prevent primary care clinician primary care provider primary care setting primary care visit primary outcome quitline randomized, clinical trials recruit secondary outcome skills skills training smoking cessation statistics stem systematic review theories web site willingness

项目摘要

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.

项目概要/摘要俄亥俄州东北部是口腔疾病（龋齿、牙周炎）发病率最高且看牙就诊率最高的地区之一专业组织和国际移民组织建议将口腔健康纳入其中。（OH）将活动纳入成人初级保健以降低医疗费用但是，已发表的文献表明。缺乏整合有效的医疗-牙科整合的结果数据也是阻碍整合的因素。例如缺乏基于电子健康记录 (EHR) 的口腔健康 (OH) 评估和转诊，以及我们的调查数据表明，大多数医疗服务提供者的职业健康教育和培训不足。提供者希望在初级保健就诊 (PCV) 时传达 OH 事实，但缺乏教育和资源。老年人对口腔疾病存在误解，导致无法定期看牙医。拟议的多层次干预措施将解决阻碍职业健康一体化的因素，并随后改善成人的自我调节行为：实践（医疗助理、护士）：EHR 系统。基于询问、建议、评估、联系的变化 (AAAC) 提供者（医生/执业护士）：改进。使用基于自我调节常识模型（CSM）理论的教育和技能的知识和技能进行培训以传达 OH 事实并强调牙科就诊的重要性。建议测试实施（实践）和行为（提供者）干预，以解决自我监管和提高 55 岁以上低收入成年人的牙科就诊率主要目标是： 1) UG3，行为。与利益相关者和实践进行定性合作；以及对干预措施进行试点测试；在 2 个实践中，将 8 个实践随机分配到两个组，以调查基于 EHR 的策略的有效性。询问[OH风险评估]、建议[去看牙医]、评估[转诊意愿]、联系的实践水平 [电子推荐和/或资源] 与提供商 CSM 理论教育和沟通 OH 的技能一起事实与单独提供者（标准或常规口腔保健）以增加牙科就诊率（主要结果）；改善 OH 生活质量、口腔卫生行为和健康生物识别指标（次要结果）。次要目标 (UH3) 是探索： AAAC 实施策略的交付和记录；调查影响结果的因果路径。样本包括 209 名提供者和医务人员，以及 800 名参加医疗补助的成年人数据分析 (UG3) 将采用混合方法设计进行定性和分析。定量数据的描述性统计（UH3）将遵循 RE-AIM 框架：成人。（来自医疗补助索赔、调查问卷、电子病历的结果数据）；实践（流程衡量标准：覆盖范围、保真度、采用率、审计维护）。方程方法将用于评估多层次干预措施对牙科就诊率和其他方面的影响结果，同时考虑实践中的聚类情况，调解方法将决定干预措施是否有效。为初级保健顾客提出了可持续的 OH 护理模式。