PROMIS oral health toolkit-supported school-based oral health program

摘要 牙病对低收入、服务不足和少数族裔儿童的影响不成比例。学校一直是 儿童健康监测和提供口腔健康服务的有效场所。然而，传统的 监测方法成本高昂，需要使用口腔健康专业人员，这限制了他们进行筛查的能力 儿童的数量很多，而且是周期性的。类似的限制也限制了以牙医为基础的 学校的口腔健康计划可以用于学生群体。因此，迫切需要一个更多的 一种高效、可行、准确的区分口腔异常与正常的口腔健康筛查方法 健康状况，并将儿童分为不同级别的口腔健康治疗需要，以便他们可以 转介进行及时和适当的牙科治疗。以我们的口腔健康宣传为基础(患者报告 结果测量信息系统)项目，该项目开发了全国第一个口腔健康 题库系统和初步有效的儿童口腔健康筛查工具包，我们的目标是建立和测试一个 校本口腔健康计划(SBOHP)，包括高效的口腔健康筛查、教育、病例 管理和推荐。这一新的SBOHP将(I)应用创新的口腔健康促进工具包(简称 表格和计算机自适应测试)，以高效和准确地识别牙齿问题并确定 牙科治疗需求的迫切性；(Ii)为学生提供有效和有针对性的口腔健康教育 牙科治疗需要迫切性和家长的健康素养水平来提高他们对牙科疾病的认识 重视口腔健康，改善他们的口腔健康行为；及。(Iii)使用学校健康起点协调员。 和学校护士提供病例管理、转诊和跟进，并提供牙科中心和 治疗来源。该SBOHP将在洛杉矶联合学校的学生中开发和测试 在基线和12个月的随访中参与SBOHP的地区，以评估可行性， 参与率、效率、口腔健康状况的变化、口腔卫生和饮食行为、拥有或使用 牙科之家，以及口腔健康状况。研究将分两个阶段进行。第一阶段--准备阶段 将风险评估纳入我们现有的以病例发现为基础的治疗转介决策； 校准口腔健康促进工具包，以适应洛杉矶联合大学学生群体中表现出的条件；验证 OHPROMIS工具包在识别未经治疗的龋病和将学生分配到治疗转诊中的准确性 针对牙科检查的类别；并制定用于测试和 评估创新的SBOHP。第二阶段-测试和评估阶段将评估可行性， SBOHP支持的口腔健康PROIS评估工具包的可接受性和有效性及其影响 SBOHP对儿童口腔健康状况和随时间推移的护理的影响。这项研究有很大的潜力提供 重要的监督信息，并成为可行、可接受、高效和可持续的学校的典范- 以口腔健康计划为基础，面向全国大量儿童。

Abstract Dental disease disproportionately affects low-income, underserved and minority children. Schools have been an effective venue for childhood health surveillance and delivery of oral health services. However, traditional surveillance methods are costly and require use of oral health professionals, which limits their ability to screen large populations of children on a periodic basis. Similar constraints also limit the extent to which dentist-based school oral health programs can be used for student populations. Thus, there is an urgent need for a more efficient, feasible and accurate oral health screening approach that can distinguish abnormal from normal oral health conditions and classify children into different levels of oral health treatment need so that they can be referred for timely and appropriate dental treatment. Building on our Oral Health PROMIS (Patient Reported Outcomes Measurement Information Systems) project, which has developed the nation’s first oral health item bank systems and initial effective oral health screening toolkits for children, we aim to establish and test a School-Based Oral Health Program (SBOHP) that includes efficient oral health screening, education, case management and referral. This novel SBOHP will (i) apply innovative Oral Health PROMIS toolkits (short form and computer adaptive testing) to efficiently and accurately identify dental problems and determine the urgency of dental treatment need; (ii) deliver effective and pertinent oral health education tailored to students’ dental treatment need urgency and parents’ health literacy levels to enhance their understanding of the importance of oral health and improve their oral health behaviors; and (iii) use school healthy start coordinators and school nurses to provide case management, referrals and follow-up with available dental hubs and treatment sources. This SBOHP will be developed and tested among students in the Los Angeles Unified School District (LAUSD), who participate in the SBOHP at baseline and 12-month follow-up, to evaluate feasibility, participation rate, efficiency, changes in oral health status, oral hygiene and diet behaviors, having or use of a dental home, and oral health status. The study will be carried out in two phases. Phase I—Preparation Phase will incorporate risk assessment into our existing case-finding-based treatment referral decision making; calibrate Oral Health PROMIS toolkits to fit conditions manifested in the LAUSD student population; validate the accuracy of OH PROMIS toolkits in identifying untreated caries and assigning students to treatment referral categories against dental examination; and develop the procedures, protocols, and documents for testing and evaluating the innovative SBOHP. Phase II—Testing and Evaluation Phase will evaluate feasibility, acceptability and efficiency of the Oral Health PROMIS assessment toolkits-supported SBOHP, and the impact of the SBOHP on children’s oral health status and care over time. The study has great potential to provide critical surveillance information and serve as a model for feasible, acceptable, efficient and sustainable school- based oral health programs for large populations of children across the country.