Reimbursement and Intensity of Dentists' Training

描述（由申请人提供）：拟议的研究是一项随机对照试验，旨在确定培训强度和第三方报销对办公室普通牙医与评估和治疗患者烟草使用相关的知识、态度和行为的有效性。将从美国牙科协会维护的主列表中随机抽取250家牙科诊所（按州分层），该主列表包括加州、亚利桑那州和内华达州的所有执业会员和非会员普通牙医。由于志愿者可能被随机分配到一组需要密集培训的戒烟治疗的牙医可能不代表人口中提供常规护理的牙医，我们将随机选择20%的牙科实践初始样本作为研究的常规护理比较组。其余80%将入组研究的干预组。干预牙医将被随机分配到四组中的一组：（1）低强度训练，（2）低强度训练加第三方报销，（3）高强度训练，或（4）高强度训练加第三方报销（即，强度×补偿的2 × 2析因设计）。口腔护理对照组牙医将不接受任何干预。在基线和干预后9个月，所有研究牙医将完成自我管理的问卷调查，内容涉及他们对患者烟草使用的评估和治疗相关的知识、态度和行为。此外，在干预后9个月，将在电话访谈期间评估患者报告的牙医在目标访视时的行为，对患者的分组不知情。届时，患者还将报告在这些目标访视中遵守牙医建议的情况。主要的结果测量将是电话采访期间的患者报告，牙医的行为在目标访问与烟草使用的评估和治疗。将使用具有强度、补偿和强度x补偿因子的广义估计方程（GEE）模型对提供者内聚集的患者报告进行组间比较。主要分析将基于四个干预组之间的意向治疗原则。次要分析将包括与常规护理组的比较。

DESCRIPTION (provided by applicant): The proposed study is a randomized, controlled trial to determine the efficacy of training intensity and of third party reimbursement on office-based, general dentists' knowledge, attitudes and behaviors related to the assessment and treatment of their patients' tobacco use. Two hundred and fifty dental practices will be randomly selected from a random sample (stratified by state) obtained from a master list maintained by the American Dental Association of all practicing member and nonmember general dentists in California, Arizona, and Nevada. Because dentists who volunteer to possibly be randomized to a group requiring intense training on tobacco cessation treatment may not be representative of dentists providing usual care in the population, we will randomly select 20% of our initial sample of dental practices for a usual-care-comparison arm of the study. The remaining 80% will be enrolled in the intervention arms of the study. Intervention dentists will be randomly assigned to one of four groups: (1) low-intensity training, (2) low-intensity training plus third-party reimbursement, (3) high-intensity training, or (4) high-intensity training plus third-party reimbursement (i.e., a 2x2 factorial design of intensity x reimbursement). Usual care comparison group dentists will receive no intervention. At baseline and at nine months post intervention, all study dentists will complete self-administered questionnaires on their knowledge, attitudes and behaviors related to their assessment and treatment of their patients' tobacco use. Also, at 9-months post-intervention, patient reports of dentists' behavior at target visits will be assessed during telephone interviews, blinded to patients' group assignment. At that time, patients will also report of compliance with dentists' recommendations at those target visits. The primary outcome measures will be patient reports during telephone interviews of dentists' behavior at target visits related to the assessment and treatment of tobacco use. Patient reports clustered within providers will be compared among groups with generalized estimating equation (GEE) models with intensity, reimbursement, and intensity x reimbursement factors. Primary analyses will be based on intention-to-treat principles among the four intervention arms. Secondary analyses will include comparisons to the usual care group.