Oral Health Equity in Alaska (OHEAL): Implementation and Evaluation of Delivery System Changes to Reduce Oral Health Disparities for Native American Children

 描述(由申请者提供)：美洲印第安人和阿拉斯加原住民(AIAN)儿童尤其受到口腔健康差异的影响：AIAN儿童的龋齿经历是白人儿童的两倍，未经治疗的龋齿发生率是白人儿童的2至3倍。尽管部落国家具有很强的韧性，但地理上的隔绝、牙医短缺以及社区对医疗保健系统的不信任加剧了不平等。在阿拉斯加，来自土著社区的牙科保健助手可以提供预防和临时护理，并担任患者导航员，以便儿童得到治疗护理。如果包括以社区为基础的联合牙科人员在内的牙科保健提供系统更有效，差距就可以缩小。然而，还没有研究评估将循证牙科治疗纳入牙科团队提供的常规护理，作为消除儿童口腔健康中种族差异的综合计划的一部分。拟议的研究(阿拉斯加口腔健康公平，OHEAL)试图通过在社区、组织、提供者、家庭和个人层面进行多层次的第四阶段实施研究，弥合研究与实践之间的差距。其目标是建立在现有系统的基础上，设计、实施和评估一系列牙科保健提供系统的变化。感兴趣的人口是7,000名儿童，2500名AIAN，生活在由东南阿拉斯加区域卫生联盟(SEARHC)服务的社区。这项干预措施将产生一个具有文化能力的、以人群为基础、以风险和证据为基础的牙科保健提供系统。病例管理、筛查、风险评估、预防和龋齿控制治疗将由初级牙科保健助理(PDHA)在其他社区环境中提供，并无缝和及时地转介给牙科保健助理治疗师(DHAT)以及牙科诊所的儿科和初级保健牙医。在积极执行框架的各个阶段之后，这项研究将采用以社区为基础的参与性研究，采用混合方法(访谈、焦点小组、调查以及前后对照研究)。其具体目标是：(1)对社区和牙科护理组织进行需求和能力评估；(2)为OHEAL的实施制定针对当地特定文化的流程和材料，以及(3)在UH3期间加强利益相关者的支持；(4)安装；(5)实施；(6)评估OHEAL模式在采用、保真度、成本和对口腔健康的影响、牙科护理的获得和质量、口腔健康方面的种族/民族公平以及在UH3期间牙科护理获取和质量方面的种族/民族公平。通过根据AIAN儿童及其所在社区的文化和社会现实调整循证做法，SEARHC将更有效地改善社区的口腔健康，并为减少儿童口腔健康方面的种族差异做出贡献。该项目是华盛顿大学(UW)太平洋西北/阿拉斯加中心减少口腔健康差距、UW土著健康研究所、UW土著健康伙伴关系、Dentex和SEARHC之间的合作。

 DESCRIPTION (provided by applicant): American Indian and Alaska Native (AIAN) children are particularly affected by disparities in oral health: AIAN children have double the caries experience of white children and 2 to 3 times higher rates of untreated caries. Despite great resilience in tribal nations, geographical isolation, dentist shortages, and community mistrust on health care systems exacerbate the inequity. In Alaska, Dental Health Aides, drawn from indigenous communities, are available to provide preventive and interim care and to serve as patient navigators so that children receive curative care. Disparities could be reduced if the dental care delivery system, including the community-based allied dental personnel, were more effective. However, no studies have yet evaluated the incorporation of evidence-based dental treatments into routine care delivered by a dental team as part of a comprehensive program to eliminate racial disparities in pediatric oral health. The proposed research (Oral Health Equity for Alaska, OHEAL) seeks to bridge the gap between research and practice by conducting a multi-level phase IV implementation study at the community, organization, provider, family and individual levels. The goal is to build on the existing system to design, implement and evaluate a series of dental care delivery system changes. The population of interest is 7,000 children, 2500 AIAN, living in communities served by the South East Alaska Regional Health Consortium (SEARHC). The intervention will result in a culturally competent, population-, risk- and evidence-based dental care delivery system. Case management, screening, risk assessment, preventive and caries arrest treatments will be delivered by Primary Dental Health Aides (PDHA) in alternative community settings, with seamless and timely referrals to Dental Health Aides Therapists (DHAT), as well as pediatric and primary care dentists at dental offices. Following the stages of the Active Implementation Framework, the study will use community-based participatory research with mixed-methods (interviews, focus groups, surveys and before and after controlled study). The specific aims are to (1) conduct a needs and capacity assessment of the communities and the dental care organization; (2) develop Native-specific culturally-appropriate processes and materials for the OHEAL implementation and (3) reinforce stakeholder support during UH2; (4) install; (5) implement; and (6) evaluate the OHEAL model in relation to adoption, fidelity, costs and impact on oral health, access and quality of dental care, racial/ethnic equity in oral health and racial/ethnic equity in dental care access and qualit during UH3. By tailoring evidence-based practices to the cultural and social reality of the AIAN children and the communities they live, SEARHC will be more efficient in improving the oral health of the communities and contribute to the reduction of racial disparities in oral health of children. This project is collaboration among University of Washington (UW) Pacific Northwest/Alaska Center to Reduce Oral Health Disparities, UW Indigenous Wellness Research Institute, UW Partnerships for Native Health, DENTEX, and SEARHC.