Developing a Decision Support System to Promote Tobacco Counseling by Dentists

描述（由申请人提供）：拟议的研究“开发一个决策支持系统，以促进牙科医生的烟草咨询”将利用全科医生的投入，开发，完善和试点测试临床决策支持系统（CDSS），牙科戒烟I-Pad（DEN-TC），用于全科牙科诊所内的戒烟。USPHS针对医疗保健提供者的戒烟指南（5' As）（Fiore等人，2008）也将指导设计。已经提出并开发了临床决策支持系统（CDSS）以支持门诊护理医师实践和儿科诊所中的5A（Marcy等人，2005年，Marcy等人，2008年，唐斯等人，2008年）。大量的调查，以及我们自己在牙科诊所的初步工作提供了证据，表明临床医生的行为与询问和建议可以实现，但其余三个A的;评估，协助和安排没有得到足够的重视，牙科服务提供者在临床设置（Albert等，2004，Albert等，2005，Gordon等，2006，Gordon等，2007）。已经发现，协助患者使用药物治疗戒烟可使戒烟几率增加约1.5 - 2倍（Silagy et al，2004，冈萨雷斯et al 2006）。安排一个积极主动的戒烟热线跟进也可以大大增加戒烟的几率。一个适合常规实践的程序，允许临床医生轻松收集患者的烟草史，相关健康史，用药史和改变/准备戒烟阶段的信息，这符合罗杰的创新扩散理论，并适合采用。本研究的一个主要目标是识别和测量CDSS的中介和调节效应。我们将使用上下文查询与多种评估方法来评估牙医的做法偏好和牙科办公室工作流程的整合。我们提出了一个两阶段的定义，可用性测试和临床测试的开发过程。将在整个研究期间编制和更新操作手册。在第1阶段，将开发和定义DEN-TC系统，我们将在牙科诊所内测试DEN-TC的有效性，并对患者进行初步临床测试。在第2阶段，我们将在一般牙科实践中对DEN-TC干预进行试点测试，以指导大规模试验的开发。拟议的项目是重要的，如果发现是成功的，Den-TC I-Pad，如一个建议，可以提高采用美国公共卫生署5A的准则在牙科诊所;创新，因为它使用iPad和苹果平台，以直接解决供应商不愿意接受和采用5A的准则，他们的烟草使用患者;使用一个健全的科学方法，是基于以前的研究;并在一个独特的适合成功完成项目的环境中汇集了一个经验丰富的调查团队

DESCRIPTION (provided by applicant): The proposed study "Developing a Decision Support System to Promote Tobacco Counseling by Dentists" will utilize input from general practice dentists to develop, refine, and pilot test a clinical decision support system (CDSS), the Dental Tobacco Cessation I-Pad (DEN-TC), for tobacco cessation within general practice dental offices. The USPHS guideline on tobacco cessation (the 5' As) for health care providers (Fiore et al., 2008) will also guide the design. Clinical Decision Support Systems (CDSS) have been proposed and developed to support the 5 A's in ambulatory care physician practices and in a pediatric clinic (Marcy et al., 2005, Marcy et al., 2008, Downs et al., 2008). Numerous investigations, and our own preliminary work in dental offices provide evidence that clinician behaviors with regard to Asking and Advising can be achieved, but that the remaining three A's; Assessing, Assisting and Arranging do not receive adequate attention by dental providers in the clinical setting (Albert et al, 2004, Albert et al, 2005, Gordon et al, 2006, Gordon et al, 2007). Assisting the patient with pharmacotherapeutics for tobacco cessation, has been found to increase the odds of quitting approximately 1.5 to 2 fold (Silagy et al, 2004, Gonzales et al 2006). Arranging for follow up with a proactive quit line can also substantially increase the odds of quitting. A program that fits into the routine of practice by allowing the clinician to easily gather information on the patient's tobacco history, relevant health history, medication history and stage of change/ readiness to quit adheres to Roger's Diffusion of Innovations theory and lends itself to adoption. A major goal of this study is to identify and measure mediating and moderating effects of the CDSS. We will use contextual inquiry with multiple evaluation methods to assess dentist practice preferences and dental office workflow integration. We propose a two-phase development process for definition, usability testing, and clinical testing. A manual of operations will be developed and updated throughout the study. In Phase 1 the DEN-TC system will be developed and defined and we will validity test the DEN-TC within dental offices and perform initial clinical testing with patients. In Phase 2 we will pilot test the DEN-TC intervention in general dental practices to guide the development of a large-scale trial. The proposed project is significant in that, if found to be successful, a Den-TC I-Pad such as the one proposed, could enhance adoption of the USPHS 5A's guidelines in dental practices; innovative because it uses iPads and the Apple platform to directly address provider reluctance to embrace and adopt the 5 A's guidelines for their tobacco using patients; uses a sound scientific approach that is based on previous research; and brings together an experienced team of investigators in an environment that is uniquely suited to the successful completion of the project