Oral Health Intervention for Intellectually/Developmentally Disabled Persons

描述（由申请人提供）：生活在家庭或团体之家的智力和/或发育障碍（IDD）的人比生活在机构的人接受更少的预防性医疗护理，并且不太可能接受常规牙科护理。这些人更有可能有口腔卫生不良，增加腐烂，牙周病比一般人群-一个显着的健康差距。更重要的是，缺碘症患者口腔健康欠佳，亦可能引致呼吸道感染，包括吸入性肺炎。这一人群的口腔健康受到损害，不仅是因为缺乏每六个月一次的预防性牙科治疗，而且因为他们不能充分刷牙和/或用牙线清洁牙齿。许多中度至重度残疾人依赖于他们的照顾者来维持口腔健康，但有证据表明，照顾者的心理社会因素是最佳口腔卫生行为的障碍。拟议的口腔健康规划补助金与进行一项为期五年的随机对照试验一起进行，该试验由病例管理人员提供基于口腔健康理论的干预。该研究将通过使用基于经验的理论框架，改进的干预策略，更大的样本量和试点测试的过程和结果措施，将先前的研究结果从试点研究扩展到不同的人群。U 01合作协议试验将是第一个结果研究，适当的权力，以评估口腔健康，相关的生活质量，和呼吸道感染的照顾者和IDD参与者在124个社区组家庭的牙科病例管理策略的影响。 两年的规划补助金要求试点测试招募策略，干预的可接受性，保真度监测方法，以及研究措施的有效性和可靠性，包括干预过程，调解人，主持人和结果。试点将在25个集体之家的护理人员中进行，约有112名缺碘症患者。在完成规划补助金后，将为临床试验（U 01合作协议）补助金申请制定完整的方案和操作手册。路易斯维尔大学和太平洋研究和评价研究所的人员将参加这些活动。 这项研究的结果将影响社会和行为研究领域，证明牙科病例管理是否能改善IDD患者的口腔健康和相关生活质量。如果结果是积极的，我们将提倡一个更大的多地点随机对照试验，以产生结果，可以推广到不同的地理区域的口腔健康差异的不同人群。最终，研究结果可能会影响医疗改革，并将牙科病例管理纳入弱势人群的医疗病例管理。 公共卫生相关性：短期而言，拟议研究的结果有可能提供证据，证明公共卫生政策应包括牙科病例管理，特别是对居住在社区的碘缺乏病患者。此外，这项研究可能表明，针对照顾者的行为干预可能会对其他依赖人群的口腔健康结果产生更大的影响。从长远来看，我们希望这项研究可以为认知障碍者的护理人员提供口腔健康干预的证据。我们相信口腔健康可以受到积极的影响，防止这些弱势群体的口腔健康和口腔健康相关的生活质量不佳，以及可能的呼吸道感染。此外，如果未来的研究表明，口腔健康结果受到这种干预的积极影响，那么整体医疗成本可能会降低，因为认知受损的人将不太需要因缺乏适当的口腔健康行为而导致的昂贵手术。

DESCRIPTION (provided by applicant): People with intellectual and/or developmental disabilities (IDD) living in family or group homes receive less preventive medical care than those living in institutions and are less likely to receive routine dental care. These individuals are more likely to have poor oral hygiene, increased decay, and periodontal disease than the general population-a significant health disparity. More importantly, poor oral health in persons with IDD may also contribute to respiratory infections including aspiration pneumonia. The oral health of this population is compromised not only by the lack of preventive dental treatment every six months but also their inability to adequately brush and/or floss their own teeth. Many of the moderately to profoundly disabled are dependent on their caregivers to maintain oral health but there is evidence that caregiver psychosocial factors serve as barriers to optimal oral hygiene behavior The proposed oral health planning grant is in conjunction with conducting a five-year randomized controlled trial with an oral health theory-based intervention delivered by case managers. The research will extend previous findings from a pilot study to a different population by using an empirical grounded theoretical framework, refined intervention strategy, larger sample size and pilot tested process and outcome measures. The U01 cooperative agreement trial would be the first outcome study properly powered to evaluate the effect of a dental case management strategy on oral health, related quality of life, and respiratory infections with caregivers and IDD participants in 124 community group homes. The two-year planning grant is requested to pilot test recruitment strategies, acceptability of the intervention, fidelity monitoring methods, and validity and reliability of study measures including intervention processes, mediators, moderators, and outcomes. The pilot will be conducted with a sample of caregivers in 25 group homes, with approximately 112 IDD participants. Upon completion of the planning grant, a full protocol and manual of operations will have been developed for the clinical trial (U01 cooperative agreement) grant application. Personnel from the University of Louisville and the Pacific Institute for Research and Evaluation will participate in these activities. The results of this study will impact the field of social and behavioral research by demonstrating whether dental case management improves the oral health and related quality of life of persons with IDD. If the results are positive, we would advocate for a larger multi-site randomized controlled trial to produce results that may be generalized to different populations with oral health disparities in diverse geographic areas. Ultimately, the results could impact healthcare reform and integrate dental case management into medical case management for disadvantaged persons. PUBLIC HEALTH RELEVANCE: In the short term, the results of the proposed study have the potential to provide evidence that public health policies should include dental case management, especially for IDD participants living in the community. Additionally, this study may show that a behavioral intervention targeting caregivers could produce a greater impact on oral health outcomes in other dependent populations. In the long term, we hope this research can develop evidence for an oral health intervention for caregivers of cognitively impaired persons. We believe oral health can be positively impacted, preventing poor oral health and oral health related quality of life, and possibly respiratory infections in these vulnerable populations. Moreover, if future studies show that oral health outcomes are positively impacted by this intervention, then the overall healthcare cost could be reduced, because cognitively impaired individuals will have less need for expensive procedures resulting from lack of proper oral health behaviors.