Multi-Level Interventions to Reduce Caries Disparities in Primary Care Settings

多层次干预措施减少初级保健机构中的龋齿差异

基本信息

批准号：
9146325
负责人：
Suchitra S. Nelson
金额：
$ 62.4万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
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/9146325
关键词：
5 year old 6 year old Academy Accounting Address Adopted Adoption Advisory Committees Affect American Awareness Behavior Therapy Behavioral Beverages Caregivers Caring Child Childhood Chronic Disease Cities Cognitive Communities Community Practice Community of Practice Country Data Data Analyses Data Collection Dental Dental Care Dental Care for Children Dental Hygiene Dental Schools Dental caries Dentists Documentation Education Educational Intervention Effectiveness Effectiveness of Interventions Eligibility Determination Emotional Enrollment Family Fluoride Varnishes Focus Groups Frequencies Group Interviews Health Health Personnel Health Services Accessibility Health education Hybrids Individual Informal Social Control Institutional Review Boards Intervention Knowledge Letters Literature Low income Maintenance Manuals Maps Measures Mediation Mediator of activation protein Medicaid Medical Methods Minority Modeling Nursery Schools Ohio Oral Oral health Outcome Pain Parents Pathway interactions Pediatric Dentistry Pediatrics Perception Phase Physicians Play Population Preventive Preventive service Primary Health Care Procedures Process Protocols documentation Provider Quality of life Questionnaires Race Randomized Randomized Clinical Trials Readiness Recommendation Reporting Research Resources Role Sampling School-Age Population Self Management Socioeconomic Status Testing Time Tooth structure Update Visit Work Writing arm base behavior test cost deciduous tooth design disparity reduction health care model health practice illness perceptions improved innovation intervention effect intervention program motivational enhancement therapy novel novel strategies oral care pediatrician primary care setting primary outcome screening secondary outcome skills statistics success theories treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Northeast Ohio has one of the highest rates of untreated cavities among poor and minority <6 yr old children. While the American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend adoption of oral health assessment within the primary care setting for children up to 6 yrs old, the evidence for such activities have been poor or lacking. Primary care clinicians can play an important role in communicating oral health (OH) facts to parent/caregivers at well-child visits (WCV) to reduce disparities in dental care access. Childhood caries is multifactorial in origin, but evidence suggests that innovative theory-driven interventions have not targeted determinants at the child-parent, provider (physician), practice/organization levels. The intervention mapping framework was used to develop the multi-level interventions: Parent: improve perception and skills - a common-sense model of self-regulation (CSM)-based OH facts letter + dental information guide (DIG); Provider (Physician): improve knowledge and skills -CSM-based education and skills, communicate OH facts, provide prescription to go to dentist; Practice (Pediatric): quality improvement -integrate systematic EMR documentation of OH, practice-tailored facilitation. A cluster-randomized clinical trial with a hybrid design is proposed to test behavioral (parent, provider) and implementation (practice) intervention to increase dental attendance among low-income children. Twenty pediatric practices will be utilized for the following primary aims: 1) UH2, Conduct formative work through community engagement and pilot-testing of the interventions and protocols in 2 practices; UH3, randomize 18 practices to four arms to investigate: 2) effect of bundled (parent + provider + practice level) interventions vs. enhanced usual care; 3) effect of behavioral and implementation components of the intervention. Secondary aims (UH3) are: assess effectiveness of interventions on secondary outcomes (new decay, oral hygiene, OHRQL, frequency of sweet snacks and beverages, cost); assess potential mediators and moderators to investigate pathways; assess adoption, reach, fidelity, maintenance measures. The sample includes 88 providers and 1584 parent/caregivers (of Medicaid- enrolled 3-6 year old children). Data analysis (UH2) will utilize a mixed method design for qualitative and descriptive/analytical statistics for quantitative data resulting from focus groups, interviews, and pilot-testing. Data collection (UH3) will follow the RE-AIM framework: child (primary, secondary outcomes from dental screening/Medicaid claims); parent, provider, practice (mediators, moderators from questionnaires); provider, practice (fidelity and implementation measures from audits). Generalized linear mixed effects models will assess effects of multi-level interventions on dental attendance and other outcomes, while accounting for clustering within family, provider and practice. Secondarily, mediation methods, accompanied by sensitivity analyses, will determine if intervention effects occur through hypothesized mediators. A comprehensive and innovative scalable oral health care model is proposed for widespread use by front-line primary care clinicians.

描述（由适用提供）：俄亥俄州东北部的贫困和少数民族少于6岁的贫困和少数民族中未经处理的空腔率最高。尽管美国儿科学院和美国儿科牙科学会建议在年龄六岁的儿童初级保健环境中通过口腔健康评估，但此类活动的证据很差或缺乏。初级保健临床医生可以通过在夫妇就诊（WCV）向父母/照顾者传达口腔健康（OH）事实中发挥重要作用，以减少牙科护理进入中的分布。儿童汽车的起源是多因素的，但证据表明，创新的理论驱动的干预措施并未针对儿童父母，提供者（医师），实践/组织级别的确定性。干预映射框架用于开发多层次干预措施：父母：提高感知和技能 - 一种常见的自我调节模型（CSM）基于基于的OH事实信函 +牙科信息指南（DIG）；提供者（医师）：提高知识和技能-CSM的教育和技能，交流OH事实，提供处方，送给牙医；练习（小儿）：质量改进 - 务实，练习量的设施的系统综合EMR文档。提出了一项带有混合设计的集群随机临床试验，以测试行为（父母，提供者）和实施（实践）干预措施，以增加低收入儿童的牙齿出勤率。以下主要目的将使用二十种儿科实践：1）UH2，通过社区参与和对两种做法中的干预措施和方案进行试验的形成性工作； UH3，将18个实践随机为四个武器进行调查：2）捆绑（父母 +提供者 +实践水平）干预措施与增强的常规护理的影响； 3）干预的行为和实施组成部分的影响。次要目的（UH3）为：干预措施对次要结果的评估有效性（新衰减，口腔卫生，OHRQL，甜食和卧室的频率，成本）；评估潜在的调解人和主持人调查途径；评估采用，覆盖范围，忠诚，维护措施。该样本包括88个提供者和1584名父母/护理人员（医疗补助招募的3-6岁儿童）。数据分析（UH2）将利用一种混合方法设计，用于定性和描述性/分析统计数据，用于由焦点组，访谈和试点测试产生的定量数据。数据收集（UH3）将遵循RE-AIM框架：儿童（牙科筛查/医疗补助索赔的主要次要结果）；父母，提供者，实践（调查员的调解人，调查员）；提供者，实践（审核的保真度和实施措施）。广义线性混合效应模型将评估多层次干预对牙齿出勤和其他结果的影响，同时考虑家庭，提供者和实践中的聚类。通过敏感性分析完成的次要调解方法将确定是否通过假设的介体发生干预效果。提出了一种全面且创新的可扩展性口腔保健模型，以供一线初级保健临床医生使用宽度。