Oral Health Intervention for Intellectually/Developmentally Disabled Persons

描述（由申请人提供）：生活在家庭或集体之家的智力和/或发育障碍（IDD）人士获得的预防性医疗护理比生活在机构的人少，而且接受常规牙科护理的可能性也更小。与一般人群相比，这些人更有可能有较差的口腔卫生、更严重的龋齿和牙周病——这是一个显著的健康差异。更重要的是，缺碘症患者口腔健康状况不佳也可能导致呼吸道感染，包括吸入性肺炎。这一人口的口腔健康受到损害，不仅是因为缺乏每六个月一次的预防性牙科治疗，而且是因为他们无法充分刷牙和（或）用牙线清洁牙齿。许多中度至重度残疾的患者依赖于他们的护理人员来维持口腔健康，但有证据表明，护理人员的心理社会因素是最佳口腔卫生行为的障碍。拟议的口腔健康计划拨款与一项为期五年的随机对照试验相结合，该试验由病例管理人员提供基于口腔健康理论的干预措施。本研究将通过使用基于经验的理论框架、完善的干预策略、更大的样本量以及试点测试过程和结果测量，将先前试点研究的结果扩展到不同的人群。U01合作协议试验将是第一个正确评估牙科病例管理策略对124个社区集体之家的护理人员和IDD参与者的口腔健康、相关生活质量和呼吸道感染影响的结果研究。申请为期两年的计划拨款用于试点测试招募策略、干预的可接受性、保真度监测方法以及研究措施的有效性和可靠性，包括干预过程、中介、调节因子和结果。该试点将在25个集体之家的护理人员样本中进行，大约有112名IDD参与者。在规划拨款完成后，将为临床试验（U01合作协议）拨款申请制定完整的方案和操作手册。路易斯维尔大学和太平洋研究与评价研究所的人员将参加这些活动。这项研究的结果将影响社会和行为研究领域，证明牙科病例管理是否能改善IDD患者的口腔健康和相关的生活质量。如果结果是积极的，我们将提倡进行更大规模的多地点随机对照试验，以产生可能推广到不同地理区域口腔健康差异的不同人群的结果。最终，研究结果可能影响医疗改革，并将牙科病例管理纳入弱势群体的医疗病例管理。

DESCRIPTION (provided by applicant): People with intellectual and/or developmental disabilities (IDD) living in family or group homes receive less preventive medical care than those living in institutions and are less likely to receive routine dental care. These individuals are more likely to have poor oral hygiene, increased decay, and periodontal disease than the general population-a significant health disparity. More importantly, poor oral health in persons with IDD may also contribute to respiratory infections including aspiration pneumonia. The oral health of this population is compromised not only by the lack of preventive dental treatment every six months but also their inability to adequately brush and/or floss their own teeth. Many of the moderately to profoundly disabled are dependent on their caregivers to maintain oral health but there is evidence that caregiver psychosocial factors serve as barriers to optimal oral hygiene behavior The proposed oral health planning grant is in conjunction with conducting a five-year randomized controlled trial with an oral health theory-based intervention delivered by case managers. The research will extend previous findings from a pilot study to a different population by using an empirical grounded theoretical framework, refined intervention strategy, larger sample size and pilot tested process and outcome measures. The U01 cooperative agreement trial would be the first outcome study properly powered to evaluate the effect of a dental case management strategy on oral health, related quality of life, and respiratory infections with caregivers and IDD participants in 124 community group homes. The two-year planning grant is requested to pilot test recruitment strategies, acceptability of the intervention, fidelity monitoring methods, and validity and reliability of study measures including intervention processes, mediators, moderators, and outcomes. The pilot will be conducted with a sample of caregivers in 25 group homes, with approximately 112 IDD participants. Upon completion of the planning grant, a full protocol and manual of operations will have been developed for the clinical trial (U01 cooperative agreement) grant application. Personnel from the University of Louisville and the Pacific Institute for Research and Evaluation will participate in these activities. The results of this study will impact the field of social and behavioral research by demonstrating whether dental case management improves the oral health and related quality of life of persons with IDD. If the results are positive, we would advocate for a larger multi-site randomized controlled trial to produce results that may be generalized to different populations with oral health disparities in diverse geographic areas. Ultimately, the results could impact healthcare reform and integrate dental case management into medical case management for disadvantaged persons. PUBLIC HEALTH RELEVANCE: In the short term, the results of the proposed study have the potential to provide evidence that public health policies should include dental case management, especially for IDD participants living in the community. Additionally, this study may show that a behavioral intervention targeting caregivers could produce a greater impact on oral health outcomes in other dependent populations. In the long term, we hope this research can develop evidence for an oral health intervention for caregivers of cognitively impaired persons. We believe oral health can be positively impacted, preventing poor oral health and oral health related quality of life, and possibly respiratory infections in these vulnerable populations. Moreover, if future studies show that oral health outcomes are positively impacted by this intervention, then the overall healthcare cost could be reduced, because cognitively impaired individuals will have less need for expensive procedures resulting from lack of proper oral health behaviors.