An implementation strategy for the adoption of an evidence-based pit-and-fissure sealant guideline by salaried dental providers: Using a framework from organizational development

项目摘要/摘要 需要有针对性的实施战略，以充分实现循证实践的好处和 牙科提供者适当使用牙科密封剂。我们研究计划的长期目标是 促进循证指南在大型、多地点牙科诊所的有效实施。第一 这项建议的步骤和目标是为美国牙科设计一个实施战略 美国牙科协会(ADA)针对牙科低粘附率的窝沟封闭剂指南 供应商。中心假设是，指导临床选择自己的实施策略，基于 关于EPIS的实施框架和列文的组织变革理论，将增加牙科 供应商对此准则的理解。我们提议的理由是，一旦我们找到了一个有效的 这一指南的实施过程，我们可以将该过程调整为适用于 牙科诊所。在研究完成后，我们预期已评估有关计划的可行性和可接受性。 制定特定地点的实施战略和实施效果的过程 战略，以增加实施美国食品药品监督管理局的坑和裂隙密封剂指南的供应商在一个大， 多点牙科诊所。确定过程和策略的有效性预计会有一个 重要的积极影响，因为这些发现很可能有助于改善口腔健康 通过制定实施策略为患者制定其他指导方针。目标1的目标是 确定影响Permanente Dental Associates(PDA)提供者当前 与ADA的窝沟指南相关的临床实践。我们的做法将是进行采访， 组织焦点小组，并在四个影响级别的每个级别进行调查。目标2的目标是评估 制定反兴奋剂机构实施战略的过程的可行性和可接受性 指导方针。我们的方法将是在一家PDA诊所试行这一过程。目标3的目标是确定 美国食品药品监督管理局指导方针实施战略的有效性。我们的方法将是比较 8个试验PDA诊所达到其目标实施目标的百分比为8 控制PDA诊所达到实验诊所的最低目标。这一点的直接贡献 预计研究将是制定一个在以下方面有效的实施战略的过程 加大ADA窝沟封闭剂指南在大型、多部位牙科的应用 练习一下。这一贡献在更广泛的范围内将是重大的，因为预计它将具有广泛的 在促进预防和治疗多种口腔疾病方面的适用性 实施有效的做法。

Project Summary/Abstract Targeted implementation strategies are needed to fully realize the benefits of evidence-based practice and the appropriate use of dental sealants by dental providers. The long-term goal of our program of research is to foster the effective implementation of evidence-based guidelines in large, multi-site dental practices. The first step and objective of this proposal is to design an implementation strategy for the American Dental Association’s (ADA) pit-and-fissure sealant guideline targeting root causes of low rates of adherence by dental providers. The central hypothesis is that guiding clinics in selecting their own implementation strategy, based on the EPIS implementation framework and Lewin’s theory for organizational change, will increase dental providers’ uptake of this guideline. The rationale for our proposal is that once we identify an effective implementation process for this guideline, we can adapt the process for other evidence-based guidelines in dental practice. By the completion of the study, we expect to have evaluated the feasibility and acceptability of a process for developing site-specific implementation strategies and the effectiveness of an implementation strategy to increase implementation of the ADA’s pit-and-fissure sealant guideline among providers in a large, multi-site dental practice. Determining the effectiveness of the process and strategies is expected to have an important positive impact, because it is likely that the findings will contribute toward better oral health for patients through the development of implementation strategies for other guidelines. The goal of Aim 1 is to identify the forces and group dynamics influencing Permanente Dental Associates (PDA) providers’ current clinical practices relative to the ADA’s pit and fissure guideline. Our approach will be to conduct interviews, run focus groups, and conduct surveys at each level of four levels of influence. The goal of Aim 2 is to assess the feasibility and acceptability of a process for developing an implementation strategy for the ADA’s guideline. Our approach will be to pilot test the process in one PDA clinic. The goal of Aim 3 is to determine the effectiveness of an implementation strategy for the ADA’s guideline. Our approach will be to compare the percentage of 8 experimental PDA clinics meeting their target implementation goal with the percentage of 8 control PDA clinics meeting the lowest of the experimental clinics’ goals. The immediate contribution of this study is expected to be the development of a process that creates an implementation strategy that is effective in increasing the implementation of the ADA’s pit-and-fissure sealant guideline in a large, multi-site dental practice. This contribution will be significant in a broader manner because it is expected to have broad applicability in facilitating the prevention and treatment of a wide range of oral diseases through enhanced implementation of effective practices.