Multi-Level Interventions to Reduce Caries Disparities in Primary Care Settings

多层次干预措施减少初级保健机构中的龋齿差异

• 批准号: 8983920
• 负责人: Suchitra S. Nelson
• 金额: $ 56.25万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-18 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8983920
• 关键词: 5 year old; 6 year old; Academy; Accounting; Address; Adopted; Adoption; Advisory Committees; Affect; American; Awareness; Behavior Therapy; Behavioral; Beverages; Caregivers; Caring; Child; Childhood; Chronic Disease; Cities; Cognitive; Communities; Community Practice; Country; Data; Data Analyses; Data Collection; Dental; Dental Care; Dental Care for Children; Dental Hygiene; Dental Schools; Dental caries; Dentists; Documentation; Education; Educational Intervention; Effectiveness; Effectiveness of Interventions; Eligibility Determination; Emotional; Enrollment; Family; Fluoride Varnishes; Focus Groups; Frequencies; Group Interviews; Health Personnel; Health Services Accessibility; Health education; Hybrids; Individual; Informal Social Control; Institutional Review Boards; Intervention; Knowledge; Letters; Literature; Low income; Maintenance; Manuals; Maps; Measures; Mediation; Mediator of activation protein; Medicaid; Medical; Methods; Minority; Modeling; Nursery Schools; Ohio; Oral health; Outcome; Pain; Parents; Pathway interactions; Pediatric Dentistry; Pediatrics; Perception; Phase; Physicians; Play; Population; Preventive; Primary Health Care; Procedures; Process; Protocols documentation; Provider; Quality of life; Questionnaires; Race; Randomized; Randomized Clinical Trials; Readiness; Recommendation; Reporting; Research; Resources; Role; Sampling; School-Age Population; Self Management; Services; Socioeconomic Status; Testing; Time; Tooth structure; Update; Visit; Work; Writing; arm; base; behavior test; cost; deciduous tooth; design; health care model; illness perceptions; improved; innovation; intervention effect; intervention program; motivational enhancement therapy; novel; novel strategies; oral care; pediatrician; primary care setting; primary outcome; public health relevance; screening; secondary outcome; skills; statistics; success; theories; treatment as usual

 DESCRIPTION (provided by applicant): Northeast Ohio has one of the highest rates of untreated cavities among poor and minority <6 yr old children. While the American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend adoption of oral health assessment within the primary care setting for children up to 6 yrs old, the evidence for such activities have been poor or lacking. Primary care clinicians can play an important role in communicating oral health (OH) facts to parent/caregivers at well-child visits (WCV) to reduce disparities in dental care access. Childhood caries is multifactorial in origin, but evidence suggests that innovative theory-driven interventions have not targeted determinants at the child-parent, provider (physician), practice/organization levels. The intervention mapping framework was used to develop the multi-level interventions: Parent: improve perception and skills - a common-sense model of self-regulation (CSM)-based OH facts letter + dental information guide (DIG); Provider (Physician): improve knowledge and skills -CSM-based education and skills, communicate OH facts, provide prescription to go to dentist; Practice (Pediatric): quality improvement -integrate systematic EMR documentation of OH, practice-tailored facilitation. A cluster-randomized clinical trial with a hybrid design is proposed to test behavioral (parent, provider) and implementation (practice) intervention to increase dental attendance among low-income children. Twenty pediatric practices will be utilized for the following primary aims: 1) UH2, Conduct formative work through community engagement and pilot-testing of the interventions and protocols in 2 practices; UH3, randomize 18 practices to four arms to investigate: 2) effect of bundled (parent + provider + practice level) interventions vs. enhanced usual care; 3) effect of behavioral and implementation components of the intervention. Secondary aims (UH3) are: assess effectiveness of interventions on secondary outcomes (new decay, oral hygiene, OHRQL, frequency of sweet snacks and beverages, cost); assess potential mediators and moderators to investigate pathways; assess adoption, reach, fidelity, maintenance measures. The sample includes 88 providers and 1584 parent/caregivers (of Medicaid- enrolled 3-6 year old children). Data analysis (UH2) will utilize a mixed method design for qualitative and descriptive/analytical statistics for quantitative data resulting from focus groups, interviews, and pilot-testing. Data collection (UH3) will follow the RE-AIM framework: child (primary, secondary outcomes from dental screening/Medicaid claims); parent, provider, practice (mediators, moderators from questionnaires); provider, practice (fidelity and implementation measures from audits). Generalized linear mixed effects models will assess effects of multi-level interventions on dental attendance and other outcomes, while accounting for clustering within family, provider and practice. Secondarily, mediation methods, accompanied by sensitivity analyses, will determine if intervention effects occur through hypothesized mediators. A comprehensive and innovative scalable oral health care model is proposed for widespread use by front-line primary care clinicians.

 描述（由申请人提供）：俄亥俄州东北部是贫困儿童和 6 岁以下少数民族儿童未经治疗蛀牙率最高的地区之一。虽然美国儿科学会和美国儿科牙科学会建议在初级保健机构中对 6 岁以下儿童进行口腔健康评估，但此类活动的证据很少或缺乏。初级保健临床医生可以在儿童健康就诊 (WCV) 中向家长/看护者传达口腔健康 (OH) 事实方面发挥重要作用，以减少牙科护理获取方面的差异。儿童龋齿的起源是多因素的，但有证据表明，创新理论驱动的干预措施并未针对儿童父母、提供者（医生）、实践/组织层面的决定因素。干预映射框架用于制定多层次干预措施： 家长：提高认知和技能 - 基于自我调节常识模型 (CSM) 的 OH 事实信 + 牙科信息指南 (DIG)；提供者（医生）：提高知识和技能-基于CSM的教育和技能，传达OH事实，提供去看牙医的处方；实践（儿科）：质量改进 - 整合 OH 的系统 EMR 文档，为实践量身定制便利。建议进行一项采用混合设计的整群随机临床试验，以测试行为（父母、提供者）和实施（实践）干预，以提高低收入儿童的牙科就诊率。二十个儿科诊所将用于以下主要目标：1) UH2，通过社区参与和对 2 个诊所的干预措施和协议进行试点测试来开展形成性工作； UH3，将 18 项实践随机分配到四个组进行调查：2）捆绑（家长 + 提供者 + 实践水平）干预措施与强化常规护理的效果； 3）干预的行为和实施成分的效果。次要目标（UH3）是：评估干预措施对次要结果（新蛀牙、口腔卫生、OHRQL、甜食和饮料的频率、成本）的有效性；评估潜在的调解者和调节者以调查途径；评估采用、覆盖范围、忠诚度、维护措施。该样本包括 88 名提供者和 1584 名家长/看护者（参加 Medicaid 的 3-6 岁儿童）。数据分析 (UH2) 将采用混合方法设计，对焦点小组、访谈和试点测试产生的定量数据进行定性和描述性/分析统计。数据收集 (UH3) 将遵循 RE-AIM 框架： 儿童（牙科筛查/医疗补助索赔的主要、次要结果）；家长、提供者、实践（调解员、问卷主持人）；提供者、实践（审计的忠诚度和实施措施）。广义线性混合效应模型将评估多层次干预措施对牙科就诊率和其他结果的影响，同时考虑家庭、提供者和实践中的聚类。其次，中介方法以及敏感性分析将确定干预效果是否通过假设的中介发生。提出了一种全面且创新的可扩展口腔保健模式，供一线初级保健临床医生广泛使用。