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Multi-Level Interventions to Reduce Caries Disparities in Primary Care Settings

多层次干预措施减少初级保健机构中的龋齿差异

基本信息

批准号：
10297159
负责人：
Suchitra S. Nelson
金额：
$ 191.76万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-18 至 2024-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10297159
关键词：
5 year old 6 year old 8 year old Academic Medical Centers Academy Accounting Adoption Advisory Committees Affordable Care Act American Awareness Behavior Therapy Behavioral Beverages California Caregivers Caring Characteristics Child Child Care Childhood Chronic Chronic Disease Clinical Trials Collaborations Communities Conduct Clinical Trials Data Data Collection Data Coordinating Center Decision Making Dental Dental Care Dental Care for Children Dental Hygiene Dental Schools Dental caries Dentists Development Devices Diffusion of Innovation Documentation Education Educational Intervention Effectiveness Effectiveness of Interventions Eligibility Determination Enrollment Evidence based intervention Fluoride Varnishes Frequencies Geographic Locations Goals Grant Health Personnel Health Resources Health Services Health Services Accessibility Health education Informal Social Control Intervention Knowledge Maintenance Mediation Mediator of activation protein Medicaid Medical Medical center Methods Minority Modeling Nurse Practitioners Nursery Schools Ohio Oral health Outcome Parents Pathway interactions Patient Education Patients Pediatric Dentistry Pediatrics Perception Physicians Play Population Preventive Preventive service Primary Health Care Process Process Measure Provider Questionnaires Race Randomized Clinical Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reporting Resources Retrospective cohort study Role Sampling San Francisco School-Age Population Self Management Socioeconomic Status Standardization Testing Time Toothache Translating Translations Trust Universities University Hospitals Update Visit Well Child Visits Work arm base care providers coping cost deciduous tooth disparity reduction dissemination strategy effectiveness evaluation effectiveness testing evidence base follow-up health care model implementation barriers implementation measures implementation strategy improved innovation intervention effect intervention mapping lower income families medication safety novel oral care pediatrician primary care setting primary outcome recruit screening secondary outcome skills skills training systematic review theories tool treatment as usual

项目摘要

PROJECT SUMMARY/ABSTRACT This competitive revision (UH3 DE025487) is to complete data collection activities for a cluster-Randomized Clinical Trial (cRCT), together with additional qualitative data collection to evaluate dissemination strategies to translate trial results and resources to all stakeholders. Northeast Ohio has one of the highest rates of untreated cavities among poor and minority <6 year old children. The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) recommend adoption of oral health activities in the primary care setting for children up to 6 years old, but evidence for such activities have been poor or lacking. Primary care clinicians can play an important role in communicating oral health (OH) facts to parent/caregivers at well- child visits (WCV) and provide resources to reduce disparities in dental care access. The intervention mapping framework was used to develop the multi-level interventions at the Provider (Physician/Nurse Practitioner): improve knowledge and skills –Common-Sense Model of Self-Regulation (CSM) theory-based education and skills, communicate OH facts, give prescription, and resources to parent/caregiver to take the child to the dentist; Practice (Pediatric): quality improvement -integrate systematic EMR documentation of OH. The cluster- randomized clinical trial randomized 18 practices to two arms. Therefore, the primary aim is to examine the effectiveness of theory-based behavioral (provider-level) and implementation (practice-level) multi-level interventions versus enhanced usual care (AAP based oral health education) delivered by providers at WCVs in increasing dental attendance among 3-6 year old Medicaid-enrolled children. The secondary aims are to: assess effectiveness of interventions on secondary outcomes (new decay, oral hygiene, OHRQL, frequency of sweet snacks and beverages, cost); assess potential mediators and moderators to investigate pathways; assess adoption, reach, fidelity, maintenance related process measures. This revision will also collect additional qualitative data to assess the characteristics of the intervention and implementation barriers/enablers for dissemination purposes. The cRCT sample includes 18 practices, 63 providers and 1024 parent/caregivers-child dyads. Data collection for the cRCT will follow the RE-AIM framework: child (primary, secondary outcomes from dental screening/Medicaid claims); parent, provider, practice (mediators, moderators from questionnaires); provider, practice (fidelity and implementation measures from audits). For the cRCT, generalized linear mixed effects models will assess effects of multi-level interventions on dental attendance and other outcomes, while accounting for clustering within provider and practice. Secondarily, mediation methods, accompanied by sensitivity analyses, will determine if intervention effects occur through hypothesized mediators. The evidence from the cRCT results and the qualitative data from this revision application will be utilized to develop a tool kit for dissemination to stakeholders. A comprehensive and innovative scalable oral health care model is proposed for widespread use by front-line primary care clinicians.

项目总结/文摘