MOLAR: Mapping Oral health and Local Area Resources

MOLAR：绘制口腔健康和当地资源图

• 批准号: 10814010
• 负责人: Margaret Emily Samuels-Kalow
• 金额: $ 101.25万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-15 至 2028-04-14
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10814010
• 关键词: MOLAR; Mapping; Oral; health; Local

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.

摘要 尽管优化口腔健康作为公共健康目标很重要，但在以下方面仍然存在显著差距 获得口腔保健和健康成果的机会。尽管已经有多项研究表明类似的 未得到满足的口腔健康需求和急诊科(ED)使用的风险因素，以及 ED对口腔健康状况的利用，利用ED访问将患者连接到 口腔保健的定义尚不明确。以前为减少使用ED解决口腔健康问题所做的努力 重点是改善获得保险的机会，但在减少急诊科就诊方面没有取得成功。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 干预措施，以减少教育署未满足的口腔健康和社会需求，同时收集信息以提供信息 随后的实施战略。我们将评估个人、卫生系统和社区层面的影响 确定和解决不良健康社会决定因素的干预措施(ASDoH)以及未满足的口腔治疗 勃起功能障碍患者的健康需求ED患者随机分为(1)区域牙科护理讲义标准 诊所，(2)地理上匹配的接受医疗补助的牙科诊所或(3)SDoH筛查+地理上- 根据需要匹配口腔健康、aSDoH和电话导航的资源以访问资源。为 目标1的主要结果将是个人在1个月时成功地与口腔保健联系起来；对于目标2， 主要结果将是口腔健康问题的回访。在目标3中，我们评估(A)的空间关联性 牙科诊所和(B)具有干预效果的社会资源，以了解社区和政策需求 成功干预的基础是连锁干预措施。拟议的工作建立在我们团队强大的 在发展基于ED的筛查方面的跟踪记录，我们的试点工作和 注册成功。这项工作为开发以患者为中心的技术提供了基线信息- 推动将口腔健康和aSDoH纳入紧急护理工作流程的可持续和 可扩展的方式。通过这样做，我们实现了NIDCR战略计划的两个主要目标：(1)使 和个性化口腔保健“，通过开发一个模型来识别急诊科的高危患者，并促进 它们与当地、可获得的社区口腔保健的联系；以及(2)使用“多学科研究” 克服差异和不平等的方法“，通过使用急诊室来招收那些没有这样做的患者 能够获得口腔保健，并确保他们连接到适当的社区资源，以便 他们的社会需求和口腔保健。通过这样做，我们解决了口腔健康不良的潜在驱动因素，并 围绕口腔保健可获得性的挑战。我们的长期目标是减轻未经治疗的患者的负担 通过将口腔健康筛查和转诊与aSDoH整合到ED中，在易感人群中发现口腔疾病 护理，从而减少潜在的可预防的急诊就诊，特别是在口腔健康状况方面。