Study protocol: A stepped-wedge, cluster-randomized trial of the effectiveness of a deliberative loop in identifying implementation strategies for the adoption of a dental sealant guideline in dental clinics.
Study protocol: A stepped-wedge, cluster-randomized trial of the effectiveness of a deliberative loop in identifying implementation strategies for the adoption of a dental sealant guideline in dental clinics.
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DOI：
10.1186/s43058-021-00199-6
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发表时间：
2021-08-28
影响因子：
--
通讯作者：
Fellows JL
中科院分区：
文献类型：
--
作者：
Polk DE;Guerrero EG;Gruß I;Shah NH;Yosuf NM;Dawson T;Kaplan CD;Pihlstrom DJ;Fellows JL
美国牙科协会（ADA）建议牙科医生在恒磨牙的咬合表面使用牙科密封剂，以预防或治疗非空腔性龋齿。尽管该指南有证据支持，但普通牙医的依从性很低，从不到5%到38.5%不等。因此，存在证据到实践的差距，并且尚不清楚哪种实施策略最能支持提供者采用和实施循证实践。选择和调整实施战略的一种潜在方法是审议循环过程，即利益相关者参与决策的方法。本试验旨在测试与利益相关者（即提供者和工作人员）一起使用审议循环干预的可接受性、可行性和有效性，使管理人员能够选择促进采用循证牙科实践的实施策略。在Kaiser Permanente Northwest dental内的16家牙科诊所将被随机分组，以确定在这个阶梯形试验中接受干预的时间。在三部分审议循环干预中，诊所利益相关者参与以下活动：(1)接收背景信息；(2)参与便利的小组讨论，旨在促进彼此从生活经验中学习，并就有效的临床层面实施策略提出知情意见；(3)与诊所领导分享他们的知情意见，后者可以根据利益相关者的知情意见选择和部署实施策略。Reach的主要结局将被定义为患者水平接受指南一致性护理。次要结果将包括审议循环过程的成本效益、可接受性和可行性。随着时间的推移，将对部署的实施战略进行分类。这些结果将确定审议循环过程可以帮助领导者选择和定制实施战略的程度，以改善指导方针一致的牙科护理。该项目已在ClinicalTrials.gov注册，ID为NCT04682730。该试验于2020年12月18日首次注册。https://clinicaltrials.gov/ct2/show/NCT04682730
The American Dental Association (ADA) recommends dental providers apply dental sealants to the occlusal surfaces of permanent molars for the prevention or treatment of non-cavitated dental caries. Despite the evidence-based support for this guideline, adherence among general dentists is low, ranging from less than 5 to 38.5%. Thus, an evidence-to-practice gap exists, and it is unclear which implementation strategies would best support providers in adopting and implementing the evidence-based practice. One potential approach to selecting and tailoring implementation strategies is a deliberative loop process, a stakeholder-engaged approach to decision-making. This trial aims to test the acceptability, feasibility, and effectiveness of using a deliberative loop intervention with stakeholders (i.e., providers and staff) to enable managers to select implementation strategies that facilitate the adoption of an evidence-based dental practice. Sixteen dental clinics within Kaiser Permanente Northwest Dental will be cluster randomized to determine the timing of receiving the intervention in this stepped-wedge trial. In the three-part deliberative loop intervention, clinic stakeholders engage in the following activities: (1) receive background information, (2) participate in facilitated small-group discussions designed to promote learning from each other’s lived experiences and develop informed opinions about effective clinic-level implementation strategies, and (3) share their informed opinions with clinic leaders, who may then choose to select and deploy implementation strategies based on the stakeholders’ informed opinions. The primary outcome of Reach will be defined as patient-level receipt of guideline-concordant care. Secondary outcomes will include the cost-effectiveness, acceptability, and feasibility of the deliberative loop process. Implementation strategies deployed will be catalogued over time. These results will establish the extent to which the deliberative loop process can help leaders select and tailor implementation strategies with the goal of improving guideline-concordant dental care. This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://clinicaltrials.gov/ct2/show/NCT04682730
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
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作者：
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DOI：
10.14219/jada.archive.2011.0324
发表时间：
2011-09-01
影响因子：
3.9
作者：
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影响因子：
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作者：
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通讯作者：
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