Development of a provider centered intervention for Non-Traumatic Dental Condition management in the Emergency Department

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PROJECT ABSTRACT This NIDCR Dual Dentist Scientist Pathway to Independence Award (K99/R00) for Tumader Khouja BDS MPH PhD, will establish Dr. Khouja as an independent oral health services researcher developing and implementing evidence-based interventions that integrate dental care into medical settings utilizing both qualitative and quantitative research methods. This long-term goal will be achieved via a 5-year training and research plan that will launch Dr. Khouja’s independent program of research and academic career and support the NIDCR’s mission to increase and maintain a strong cohort of new and talented independent dual degree dentist scientists. The career goals of this program are: (1) training in intervention sciences [and biomedical informatics]; (2) gain expertise in qualitative methods to inform, design, and evaluate theoretically based behavioral interventions, and (3) professional development as an independent researcher. These career goals will be achieved via formal coursework, trainings, national conferences, mentorship, and research experience. The overall objective of this proposal is to understand the barriers and facilitators to non-traumatic dental condition (NTDC) management in the emergency department (ED) through quantitative and qualitative methods. The first aim will determine the national variation in NTDC prescribing in the ED and subsequent ED/urgent care revisits and hospitalizations within 30-days of an index ED visit. Using national electronic health records and integrated claims datasets and a random effects model, we will identify factors associated with prescribing for NTDC and variation at the patient, provider, hospital and state levels. The second aim identifies ED providers’ perceived barriers and facilitators to the management of NTDC in the ED. Using individual in depth interviews, ED providers (physicians, advanced practice providers) will identify the facilitators and barriers to management and prescribing for NTDC in the ED. The third aim will pilot and refine a multifaceted approach for NTDC prescribing in the ED and assess the acceptability and feasibility of the implementation of this strategy in ED settings. We will develop a 2-level interventional strategy [using human centered design methods] that will aid ED providers in NTDC prescribing and refine it based on our findings from the previous aims and field experience. As we test the intervention in an ED, we will use [EHR data from the University of Pittsburgh Medical Center (UPMC) to] evaluate appropriate treatment and clinician experience with ED use for NTDC before and during the intervention. Further trials will test the effectiveness of the intervention in U- and/or R-level proposals. An outstanding interprofessional team comprised of a public health dentist, pharmacist, ED physician, behavioral psychologist, biostatistician [and biomedical infromatician] will provide mentorship to ensure the success of this project. The long-term goal of this program of research is to develop a generalizable and sustainable intervention to improve NTDC management in ED and other medical settings. [This work supports priorities of the U.S. Surgeon General, NIH Director, and NIDCR to integrate oral health and general health through collaborative alliances and creating a diverse pipeline of clinician oral health researchers.]