Multi-Level Interventions to Reduce Oral Health Disparities among Adults in Primary Care Settings

多层次干预措施减少初级保健机构成年人之间的口腔健康差异

• 批准号: 10633139
• 负责人: Suchitra S. Nelson
• 金额: $ 32.23万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-02 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10633139
• 关键词: Academy; Address; Adoption; Adult; Affect; Aging; Attention; Behavior; Behavior Therapy; Behavioral; Belief; Biometry; Caring; Child Health; Cognitive; Collaborations; Communication; Community Practice; Data; Data Analyses; Data Collection; Dental; Dental Care; Dental Hygiene; Dental caries; Dentists; Diagnosis; Documentation; Education; Educational Curriculum; Elderly; Electronic Health Record; Electronics; Enrollment; Equation; Exclusion; Health; Health education; Health system; Healthcare; Hospitalization; Informal Social Control; Intervention; Knowledge; Literature; Low income; Maintenance; Manuals; Measures; Mediation; Mediator; Medicaid; Medicaid eligibility; Medical; Medical Care Costs; Medical Staff; Medicare; Medicine; Methods; Modeling; Mouth Diseases; Nurse Practitioners; Nurses; Ohio; Oral cavity; Oral health; Outcome; Outcomes Research; Paper; Pathway interactions; Patients; Perception; Periodontitis; Personal Satisfaction; Phase; Physicians; Physicians' Offices; Population; Primary Care; Printing; Procedures; Process; Process Measure; Professional Organizations; Protocols documentation; Provider; Publishing; Quality of life; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recommendation; Reporting; Resources; Risk Assessment; Risk Factors; Sample Size; Sampling; Site; Source; Structure; Surveys; System; Systemic disease; Testing; Tooth Diseases; Tooth Loss; Tooth structure; Training; Training and Education; Trust; United States National Institutes of Health; Universities; Visit; Work; Writing; aged; arm; behavior change; behavior influence; behavioral and social science; burden of illness; design; efficacy testing; electronic health record system; experience; health assessment; health care model; health disparity; health training; implementation strategy; improved; innovation; intervention effect; novel; oral communication; pilot test; prevent; primary care clinician; primary care provider; primary care setting; primary care visit; primary outcome; quitline; randomized, clinical trials; recruit; secondary outcome; skills; skills training; smoking cessation; statistics; stem; systematic review; theories; web site; willingness

PROJECT SUMMARY/ABSTRACT Northeast Ohio has one of the highest rates of oral diseases (caries, periodontitis) and poor dental attendance among low-income older adults. Professional organizations and the IOM recommend integration of oral health (OH) activities into primary care for adults in order to reduce medical costs. But, published literature indicates a lack of outcomes data to assemble an effective medical-dental integration. Impeding integration are also factors such as lack of an electronic health record (EHR) based oral health (OH) assessment and referral, and inadequate OH education and training for medical providers. Our survey data indicate that the majority of providers would like OH facts to be communicated at primary care visits (PCV) but lack education and resources. There are misperceptions about oral diseases among older adults that prevent regular dental attendance. The proposed multi-level interventions will address factors that impede OH integration, and subsequently improve self-regulatory behaviors in adults. The interventions are: Practice (medical assistants, nurses): EHR systems based changes to ask, advise, assess, connect (AAAC). Provider (physician/nurse practitioner): improve knowledge and skills using Common-Sense Model of Self-Regulation (CSM) theory based education and skills training to communicate OH facts and reinforce importance of dental visits. A cluster-randomized clinical trial is proposed to test implementation (practice) and behavioral (provider) intervention to address self-regulation and increase dental attendance among low-income adults aged ≥55 years. The primary aims are: 1) UG3, Conduct qualitative work with stakeholders and practices; system-based changes in EHR; and pilot-test the interventions in 2 practices. UH3, randomize 8 practices to two arms to investigate the efficacy of a EHR based strategy at the practice level to ask [OH risk assessment], advise [going to dentist], assess [willingness for referral], connect [eReferral and/or resources] together with provider CSM theory-based education and skills to communicate OH facts versus provider alone (standard or usual oral health care) to increase dental attendance (primary outcome); and improve OH quality of life, oral hygiene behavior, and biometric measures of health (secondary outcomes). Secondary aims (UH3) are to explore: the delivery and documentation of AAAC implementation strategy; and to investigate causal pathways that affect the outcomes. The sample includes 209 providers and medical staff, and 800 Medicaid-enrolled adults. Data analysis (UG3) will utilize a mixed method design for qualitative and descriptive statistics for quantitative data. Data collection (UH3) will follow the RE-AIM framework: adults (outcome data from Medicaid claims, questionnaires, EHR); provider, practice (questionnaires); provider, practice (process measures: reach, fidelity, adoption, maintenance from audits). A generalized estimating equations approach will be used to assess effects of multi-level interventions on dental attendance and other outcomes, while accounting for clustering within practice. Mediation methods will determine if intervention effects occur through hypothesized mediators. A sustainable OH care model is proposed for primary care clinicians.

项目概要/摘要 俄亥俄州东北部是口腔疾病（龋齿、牙周炎）发病率最高且看牙就诊率最高的地区之一 在低收入老年人中。专业组织和国际移民组织建议整合口腔健康 (OH) 将活动纳入成人初级保健，以降低医疗费用。但是，已发表的文献表明 缺乏结果数据来整合有效的医疗-牙科整合。阻碍整合也是因素 例如缺乏基于电子健康记录 (EHR) 的口腔健康 (OH) 评估和转诊，以及 对医疗服务提供者的职业健康教育和培训不足。我们的调查数据表明，大多数 提供者希望在初级保健就诊 (PCV) 时传达 OH 事实，但缺乏教育和资源。 老年人对口腔疾病存在误解，导致无法定期看牙医。这 拟议的多层次干预措施将解决阻碍职业健康一体化的因素，并随后改善 成人的自我调节行为。干预措施包括： 实践（医疗助理、护士）：EHR 系统 基于询问、建议、评估、联系（AAAC）的变化。提供者（医生/执业护士）：改善 使用基于自我调节常识模型（CSM）理论的教育和技能的知识和技能 培训以传达 OH 事实并强调看牙医的重要性。整群随机临床试验是 建议测试实施（实践）和行为（提供者）干预，以解决自我监管和 提高 55 岁以上低收入成年人的牙科就诊率。主要目标是：1) UG3，行为 与利益相关者和实践的定性工作；电子病历系统的变化；并对干预措施进行试点测试 在2个实践中。 UH3，将 8 项实践随机分配到两个组，以调查基于 EHR 的策略的有效性 询问[OH风险评估]、建议[去看牙医]、评估[转诊意愿]、连接的实践水平 [电子推荐和/或资源] 与提供商 CSM 理论教育和沟通 OH 的技能一起 事实与单独提供者（标准或常规口腔保健）以增加牙科就诊率（主要结果）； 改善 OH 生活质量、口腔卫生行为和健康生物识别指标（次要结果）。 次要目标 (UH3) 是探索： AAAC 实施策略的交付和记录；并到 研究影响结果的因果路径。样本包括 209 名提供者和医务人员，以及 800 名参加医疗补助的成年人。数据分析（UG3）将利用混合方法设计进行定性和 定量数据的描述性统计。数据收集 (UH3) 将遵循 RE-AIM 框架：成人 （来自医疗补助索赔、调查问卷、电子病历的结果数据）；提供者、实践（调查问卷）；提供者, 实践（流程衡量标准：范围、保真度、采用、审计维护）。广义估计 方程方法将用于评估多层次干预措施对牙科就诊率和其他方面的影响 结果，同时考虑实践中的聚类。调解方法将决定干预效果 通过假设的中介发生。为初级保健临床医生提出了可持续的 OH 护理模式。