MOLAR: Mapping Oral health and Local Area Resources

MOLAR：绘制口腔健康和当地资源图

基本信息

批准号：
10445530
负责人：
Margaret Emily Samuels-Kalow
金额：
$ 51.96万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-15 至 2023-04-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10445530
关键词：
Accident and Emergency department Address Antibiotics Area Caring Color Communities Dental Dental Clinics Dental Insurance Dentists Development Diagnostic Procedure Diagnostic tests Disease Effectiveness of Interventions Emergency Care Emergency Department patient Emergency department visit Enrollment Ensure Frequencies Geographic Distribution Geography Goals Grant Health Health Personnel Health Resources Health Services Health Services Accessibility Health system Healthcare Healthcare Systems High Prevalence Homelessness Improve Access Individual Inequality Insurance Interdisciplinary Study Intervention Intervention Trial Low income Medicaid Mission Modeling Morbidity - disease rate Mouth Diseases National Institute of Dental and Craniofacial Research Neighborhoods Oral health Outcome Paper Patients Policies Population Populations at Risk Primary Health Care Process Proctor framework Provider Public Health Randomized Randomized Controlled Trials Research Resources Risk Risk Factors Role Schools Screening procedure Site Strategic Planning Technology Telephone Testing Text Messaging Time Tooth Diseases Toothache Treatment Efficacy Visit Vulnerable Populations Work adverse outcome base comorbidity density dental infection effectiveness implementation study ethnic minority food insecurity health disparity health goals health inequalities health related quality of life implementation framework implementation strategy improved improved outcome opioid use disorder patient oriented patient population prescription opioid primary outcome racial minority safety net satisfaction screening secondary outcome social social health determinants standard care standard of care success successful intervention

项目摘要

Abstract Despite the importance of optimizing oral health as a public health goal, there remain significant disparities in access to oral health care and in health outcomes. Although there have been multiple studies showing similar risk factors for unmet oral health needs and emergency department (ED) utilization, and a high frequency of ED utilization for oral health conditions, the optimal strategy for leveraging an ED visit to connect patients to oral health care remains to be defined. Previous efforts to reduce ED utilization for oral health problems have focused on improving access to insurance and have not been successful in reducing ED visits. This project would use a hybrid effectiveness-implementation study to perform a randomized controlled trial of an intervention to reduce unmet oral health and social needs in the ED, while collecting information to inform subsequent implementation strategies. We will assess individual, health system and community level impacts of an intervention to identify and address adverse social determinants of health (aSDoH) along with unmet oral health needs among ED patients. ED patients randomized to (1) standard of care handout of regional dental clinics, (2) geographically-matched Medicaid-accepting dental clinics or (3) aSDoH screening + geographically- matched resources for oral health and aSDoH and phone navigation as necessary to access resources. For Aim 1, the primary outcome will be individual successful linkage to oral health care at 1 month; for Aim 2, the primary outcome will be return visits for oral health concerns. In Aim 3, we assess the spatial association of (a) dental clinics and (b) social resources with intervention efficacy to understand the community and policy needs underlying successful intervention of linkage interventions. The proposed work builds on our team’s strong track record in development of ED-based screening, with feasibility demonstrated by our pilot work and successful enrollment. This work provides the baseline information to develop a patient-centered, technology- driven strategy to integrate oral health and aSDoH into the emergency care workflow in a sustainable and scalable way. In doing so, we fulfill two of the primary goals of the NIDCR Strategic Plan: (1) Enabling “precise and personalized oral health care” by developing a model to identify patients at risk in the ED and facilitating their connection to local, accessible, community oral health care; and (2) Using “multidisciplinary research approaches to overcome disparities and inequalities” by using the ED to enroll patients who do not otherwise have access to oral health care and ensure that they are connected to appropriate community resources for their social needs and oral health care. By doing so, we address the potential drivers of poor oral health and the challenges around accessibility of oral health care. Our long-term goal is to reduce the burden of untreated oral disease in vulnerable populations by integrating screening and referral for oral health and aSDoH into ED care, and thereby reduce potentially preventable ED visits, particularly for oral health conditions.

抽象的尽管将口腔健康作为公共卫生目标的重要性很重要，但仍有重大分布获得口腔卫生保健和健康成果。尽管有多项研究表明类似未满足口腔健康需求的风险因素和急诊室（ED）利用率，高频的高频 ED利用用于口腔健康状况，这是利用ED访问将患者联系到的最佳策略口腔卫生保健仍有待定义。以前为了减少口腔健康问题的ED利用的努力已有专注于改善获得保险的机会，并且没有成功地减少ED访问。这个项目将使用混合有效性实施研究来执行一项随机对照试验干预以减少急诊室中未满足的口腔健康和社会需求，同时收集信息以告知随后的实施策略。我们将评估个人，卫生系统和社区级别的影响干预措施以识别和解决广告社会确定健康（ASDOH）以及未满足的口头 ED患者的健康需求。 ED患者随机分配给（1）区域牙科的护理标准讲义诊所，（2）地理匹配的医疗补助诊所或（3）ASDOH筛查 +地理上 - 根据需要匹配口腔健康以及ASDOH和电话导航的资源，以访问资源。为了 AIM 1，主要结果将是1个月的个人成功与口腔医疗保健联系；对于目标2，主要结果将是口腔健康问题的回访。在AIM 3中，我们评估了（a）的空间关联牙科诊所和（b）具有干预效率的社会资源，以了解社区和政策需求成功干预措施的基本干预措施。拟议的工作以我们团队的强大为基础基于ED的筛查开发中的记录，我们的飞行员工作证明了可行性成功入学。这项工作提供了基线信息，以开发以患者为中心的技术 - 以可持续性和可扩展的方式。这样，我们实现了NIDCR战略计划的两个主要目标：（1）实现“精确和个性化的口腔保健”，通过开发一个模型来识别ED风险的患者并促进他们与本地，可访问，社区口腔卫生保健的联系；（2）使用“多学科研究通过使用ED来招募没有其他情况的患者来克服分布和不平等的方法” 有权获得口腔卫生保健，并确保它们与适当的社区资源联系起来他们的社会需求和口腔保健。这样，我们解决了口腔健康状况不佳的潜在驱动因素以及口腔医疗保健的可及性面临的挑战。我们的长期目标是减少未经处理的燃烧通过将口腔健康和ASDOH的筛查和转诊纳入ED，口腔疾病在脆弱人群中护理，从而减少可能预防的ED访问，特别是对于口腔健康状况。