MOLAR: Mapping Oral health and Local Area Resources

摘要 尽管优化口腔健康作为公共卫生目标的重要性， 获得口腔保健和健康结果。尽管有多项研究表明， 未满足的口腔健康需求和急诊（艾德）利用的风险因素，以及 口腔健康状况的艾德利用，利用艾德就诊将患者与 口腔保健仍有待确定。先前减少艾德用于口腔健康问题的努力， 重点是改善获得保险的机会，但在减少艾德就诊方面并不成功。这个项目 将使用混合有效性-实施研究进行一项随机对照试验， 干预措施，以减少未满足的口腔健康和社会需求的艾德，同时收集信息， 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 采取干预措施，以确定和解决健康的不利社会决定因素（aSDoH）沿着 艾德患者的健康需求。艾德患者被随机分配至（1）区域牙科护理手册标准组 诊所，（2）地理上匹配的接受医疗补助的牙科诊所或（3）aSDoH筛查+地理上- 匹配口腔健康和aSDoH的资源，并根据需要进行电话导航以访问资源。为 目标1，主要结果将是1个月时个体与口腔保健的成功联系;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 牙科诊所及（B）具干预效用的社会资源，以了解社区及政策需要 联系干预的成功干预的基础。这项工作建立在我们团队强大的 在发展以急症室为基础的检查方面的往绩，我们的试验工作已证明其可行性， 成功注册。这项工作提供了基线信息，以开发以患者为中心的技术， 以可持续的方式将口腔健康和aSDoH整合到紧急护理工作流程中， 可扩展的方式。在这样做的过程中，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，以确定患者在艾德的风险，并促进 他们与当地的，可获得的，社区口腔卫生保健的联系;和（2）使用“多学科研究” 通过使用艾德招募那些在其他情况下不需要的患者， 获得口腔保健，并确保他们与适当的社区资源相联系， 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， 口腔卫生保健的可及性面临的挑战。我们的长期目标是减少未经治疗的 通过将口腔健康和aSDoH的筛查和转诊整合到艾德中， 护理，从而减少潜在的可预防的艾德就诊，特别是口腔健康状况。

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.