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：
8983920
负责人：
Suchitra S. Nelson
金额：
$ 56.25万
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/8983920
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 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 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 health Outcome Pain Parents Pathway interactions Pediatric Dentistry Pediatrics Perception Phase Physicians Play Population Preventive 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 Services Socioeconomic Status Testing Time Tooth structure Update Visit Work Writing arm base behavior test cost deciduous tooth design health care model illness perceptions improved innovation intervention effect intervention program motivational enhancement therapy novel novel strategies oral care pediatrician primary care setting primary outcome public health relevance 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（由申请人提供）：俄亥俄州东北部是贫困儿童和少数民族 6 岁以下儿童蛀牙未治疗率最高的地区之一，而美国儿科学会和美国儿科牙科学会建议在小学阶段采用口腔健康评估。在 6 岁以下儿童的护理环境中，此类活动的证据很少或缺乏。初级护理婴儿在儿童就诊时向家长/护理人员传达口腔健康 (OH) 事实方面可以发挥重要作用。（WCV）减少儿童龋齿的根源是多因素的，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（医生）、实践/组织层面的决定因素。使用框架来制定多层次干预措施：家长：提高认知和技能 - 基于自我调节常识模型 (CSM) 的 OH 事实信 + 牙科信息指南 (DIG)：提高知识；和技能 - 基于 CSM 的教育和技能，传达 OH 事实，提供去看牙医的处方；实践（儿科）：质量改进 - 整合 OH 的系统 EMR 文档，根据实践定制便利化采用混合设计的集群随机临床试验。建议测试行为（家长、提供者）和实施（实践）干预，以提高低收入儿童的牙科就诊率，将利用 20 种儿科实践来实现以下主要目标：1) UH2，通过社区参与和开展形成性工作。对 2 个实践中的干预措施和协议进行试点测试；UH3，将 18 个实践随机分配到四个组进行调查：2) 捆绑（家长 + 提供者 + 实践水平）干预措施与强化常规护理的效果 3) 行为和实施的效果；干预措施的组成部分（UH3）是：评估干预措施对次要结果（新腐烂、口腔卫生、OHRQL、甜食和饮料的频率、成本）的有效性；样本包括 88 名提供者和 1584 名家长/看护者（参加 Medicaid 的 3-6 岁儿童）。数据分析 (UH2) 将采用混合方法设计进行定性和描述性/分析统计。焦点小组、访谈和试点测试产生的数据 (UH3) 将遵循 RE-AIM 定量框架：儿童（牙科筛查/医疗补助索赔的主要、次要结果）；（调查问卷中的调解员、主持人）；提供者、实践（审计中的保真度和实施措施）将评估多层次干预措施对牙科就诊和其他结果的影响，同时考虑家庭、提供者和实践中的聚类。其次，结合敏感性分析的调解方法将确定干预效果是否通过突击调解产生，并提出了一种全面且创新的可扩展口腔保健模型，供一线初级保健狂热分子广泛使用。