Reimbursement and Intensity of Dentists' Training

描述（由申请人提供）：本研究是一项随机对照试验，旨在确定培训强度和第三方报销对门诊、普通牙医评估和治疗患者烟草使用相关知识、态度和行为的效果。250个牙科诊所将从美国牙科协会维护的加利福尼亚、亚利桑那和内华达州所有执业会员和非会员普通牙医的总名单中随机抽取（按州分层）。由于自愿被随机分配到需要进行戒烟治疗强化培训的一组的牙医可能不能代表在人群中提供常规护理的牙医，我们将随机选择20%的牙科实践初始样本作为研究的常规护理比较组。剩下的80%将被纳入研究的干预组。干预牙医将被随机分配到以下四组：(1)低强度培训、(2)低强度培训加第三方报销、(3)高强度培训或(4)高强度培训加第三方报销（即强度x报销的2x2析因设计）。常规护理对照组的牙医将不接受干预。在基线和干预后9个月，所有参与研究的牙医都将完成自我管理的问卷调查，内容涉及他们对患者烟草使用的评估和治疗相关的知识、态度和行为。此外，在干预后9个月，患者在目标就诊时的牙医行为报告将在电话访谈中进行评估，对患者分组不知情。届时，患者还将报告在这些目标就诊时是否遵守了牙医的建议。主要结果测量将是患者在电话采访中报告牙医在目标就诊时与评估和治疗烟草使用有关的行为。聚集在提供者内的患者报告将在具有强度、报销和强度x报销因素的广义估计方程（GEE）模型组之间进行比较。初步分析将基于四个干预组的意向-治疗原则。二次分析将包括与常规护理组的比较。

DESCRIPTION (provided by applicant): The proposed study is a randomized, controlled trial to determine the efficacy of training intensity and of third party reimbursement on office-based, general dentists' knowledge, attitudes and behaviors related to the assessment and treatment of their patients' tobacco use. Two hundred and fifty dental practices will be randomly selected from a random sample (stratified by state) obtained from a master list maintained by the American Dental Association of all practicing member and nonmember general dentists in California, Arizona, and Nevada. Because dentists who volunteer to possibly be randomized to a group requiring intense training on tobacco cessation treatment may not be representative of dentists providing usual care in the population, we will randomly select 20% of our initial sample of dental practices for a usual-care-comparison arm of the study. The remaining 80% will be enrolled in the intervention arms of the study. Intervention dentists will be randomly assigned to one of four groups: (1) low-intensity training, (2) low-intensity training plus third-party reimbursement, (3) high-intensity training, or (4) high-intensity training plus third-party reimbursement (i.e., a 2x2 factorial design of intensity x reimbursement). Usual care comparison group dentists will receive no intervention. At baseline and at nine months post intervention, all study dentists will complete self-administered questionnaires on their knowledge, attitudes and behaviors related to their assessment and treatment of their patients' tobacco use. Also, at 9-months post-intervention, patient reports of dentists' behavior at target visits will be assessed during telephone interviews, blinded to patients' group assignment. At that time, patients will also report of compliance with dentists' recommendations at those target visits. The primary outcome measures will be patient reports during telephone interviews of dentists' behavior at target visits related to the assessment and treatment of tobacco use. Patient reports clustered within providers will be compared among groups with generalized estimating equation (GEE) models with intensity, reimbursement, and intensity x reimbursement factors. Primary analyses will be based on intention-to-treat principles among the four intervention arms. Secondary analyses will include comparisons to the usual care group.