An implementation strategy for the adoption of an evidence-based pit-and-fissure sealant guideline by salaried dental providers: Using a framework from organizational development

项目总结/摘要 需要有针对性的实施战略，以充分实现循证实践的益处， 牙科服务提供者正确使用牙科密封剂。我们研究计划的长期目标是 促进在大型、多地点牙科诊所中有效实施循证指南。第一 本提案的步骤和目标是为美国牙科设计一个实施战略， 美国牙科协会（ADA）的窝沟封闭指南，针对牙科治疗依从性低的根本原因， 提供商中心假设是，指导诊所选择自己的实施策略， EPIS实施框架和Lewin的组织变革理论，将增加牙科 供应商对该指南的理解。我们的建议的理由是，一旦我们确定了一个有效的 本指南的实施过程，我们可以调整其他循证指南的过程， 牙科诊所在研究完成时，我们预期已评估以下各项的可行性和可接受性： 制定具体地点实施战略的过程和实施的有效性 战略，以增加实施ADA的坑和裂缝密封指南之间的供应商在一个大的， 多地点牙科实践。确定过程和战略的有效性， 重要的积极影响，因为这一发现可能有助于改善口腔健康， 通过制定患者实施策略等指南。目标1的目标是 确定影响永久牙科协会（PDA）提供者当前 与ADA的窝沟指南相关的临床实践。我们的方法是进行面谈， 运行焦点小组，并在四个影响力级别的每个级别进行调查。目标2的目标是评估 为《反倾销协定》制定实施战略的程序的可行性和可接受性 指导方针。我们的方法将是在一个PDA诊所进行试点测试。目标3的目标是确定 ADA指导方针实施战略的有效性。我们的方法是比较 8个实验性PDA诊所达到其目标实施目标的百分比， 控制PDA诊所达到最低的实验诊所的目标。这件事的直接贡献 研究预计将是一个过程，创建一个有效的执行战略， 在大型多部位牙科诊所中增加ADA窝沟封闭指南的实施 实践这一贡献在更广泛的意义上是重要的，因为预计它将具有广泛的 适用于预防和治疗多种口腔疾病， 实施有效的做法。

Project Summary/Abstract Targeted implementation strategies are needed to fully realize the benefits of evidence-based practice and the appropriate use of dental sealants by dental providers. The long-term goal of our program of research is to foster the effective implementation of evidence-based guidelines in large, multi-site dental practices. The first step and objective of this proposal is to design an implementation strategy for the American Dental Association’s (ADA) pit-and-fissure sealant guideline targeting root causes of low rates of adherence by dental providers. The central hypothesis is that guiding clinics in selecting their own implementation strategy, based on the EPIS implementation framework and Lewin’s theory for organizational change, will increase dental providers’ uptake of this guideline. The rationale for our proposal is that once we identify an effective implementation process for this guideline, we can adapt the process for other evidence-based guidelines in dental practice. By the completion of the study, we expect to have evaluated the feasibility and acceptability of a process for developing site-specific implementation strategies and the effectiveness of an implementation strategy to increase implementation of the ADA’s pit-and-fissure sealant guideline among providers in a large, multi-site dental practice. Determining the effectiveness of the process and strategies is expected to have an important positive impact, because it is likely that the findings will contribute toward better oral health for patients through the development of implementation strategies for other guidelines. The goal of Aim 1 is to identify the forces and group dynamics influencing Permanente Dental Associates (PDA) providers’ current clinical practices relative to the ADA’s pit and fissure guideline. Our approach will be to conduct interviews, run focus groups, and conduct surveys at each level of four levels of influence. The goal of Aim 2 is to assess the feasibility and acceptability of a process for developing an implementation strategy for the ADA’s guideline. Our approach will be to pilot test the process in one PDA clinic. The goal of Aim 3 is to determine the effectiveness of an implementation strategy for the ADA’s guideline. Our approach will be to compare the percentage of 8 experimental PDA clinics meeting their target implementation goal with the percentage of 8 control PDA clinics meeting the lowest of the experimental clinics’ goals. The immediate contribution of this study is expected to be the development of a process that creates an implementation strategy that is effective in increasing the implementation of the ADA’s pit-and-fissure sealant guideline in a large, multi-site dental practice. This contribution will be significant in a broader manner because it is expected to have broad applicability in facilitating the prevention and treatment of a wide range of oral diseases through enhanced implementation of effective practices.