Developing a Decision Support System to Promote Tobacco Counseling by Dentists

描述（由申请人提供）：拟议的研究“开发决策支持系统以促进牙医的烟草咨询”将利用全科牙医的投入来开发、完善和试点测试临床决策支持系统（CDSS），即牙科戒烟I-Pad (DEN-TC)，用于全科牙科诊所的戒烟。美国公共卫生服务部针对卫生保健提供者的戒烟指南（5' a） （Fiore等人，2008年）也将指导设计。临床决策支持系统（CDSS）已被提出和开发，以支持门诊护理医师实践和儿科诊所的5a （Marcy等人，2005年，Marcy等人，2008年，Downs等人，2008年）。大量的调查和我们自己在牙科诊所的初步工作提供了证据，证明临床医生在询问和建议方面的行为是可以实现的，但剩下的三个A；评估、协助和安排在临床环境中没有得到牙科提供者的足够重视（Albert等人，2004年，Albert等人，2005年，Gordon等人，2006年，Gordon等人，2007年）。研究发现，帮助患者使用药物治疗戒烟可使戒烟几率增加约1.5至2倍（Silagy et al ., 2004; Gonzales et al ., 2006）。安排积极主动的戒烟热线也可以大大增加戒烟的几率。通过允许临床医生轻松地收集有关患者吸烟史、相关健康史、用药史和改变/准备戒烟阶段的信息，适合日常实践的程序符合罗杰的创新扩散理论，并使其易于采用。本研究的主要目的是确定和测量CDSS的中介和调节作用。我们将使用上下文查询与多种评估方法来评估牙医实践偏好和牙科办公室工作流程集成。我们提出了一个定义、可用性测试和临床测试的两阶段开发过程。在整个研究期间将编制和增订一份业务手册。在第一阶段，我们将开发和定义DEN-TC系统，我们将在牙科诊所内对DEN-TC进行有效性测试，并对患者进行初步临床测试。在第二阶段，我们将在普通牙科实践中试点测试DEN-TC干预措施，以指导大规模试验的发展。建议的项目意义重大，因为如果发现成功，如建议的denc I-Pad，可以促进USPHS 5A指南在牙科诊所的采用；创新之处在于，它使用ipad和苹果平台，直接解决了供应商不愿接受和采用5a指导方针的问题；采用基于以往研究的可靠的科学方法；并将经验丰富的调查团队聚集在一个独特的环境中，适合于项目的成功完成

DESCRIPTION (provided by applicant): The proposed study "Developing a Decision Support System to Promote Tobacco Counseling by Dentists" will utilize input from general practice dentists to develop, refine, and pilot test a clinical decision support system (CDSS), the Dental Tobacco Cessation I-Pad (DEN-TC), for tobacco cessation within general practice dental offices. The USPHS guideline on tobacco cessation (the 5' As) for health care providers (Fiore et al., 2008) will also guide the design. Clinical Decision Support Systems (CDSS) have been proposed and developed to support the 5 A's in ambulatory care physician practices and in a pediatric clinic (Marcy et al., 2005, Marcy et al., 2008, Downs et al., 2008). Numerous investigations, and our own preliminary work in dental offices provide evidence that clinician behaviors with regard to Asking and Advising can be achieved, but that the remaining three A's; Assessing, Assisting and Arranging do not receive adequate attention by dental providers in the clinical setting (Albert et al, 2004, Albert et al, 2005, Gordon et al, 2006, Gordon et al, 2007). Assisting the patient with pharmacotherapeutics for tobacco cessation, has been found to increase the odds of quitting approximately 1.5 to 2 fold (Silagy et al, 2004, Gonzales et al 2006). Arranging for follow up with a proactive quit line can also substantially increase the odds of quitting. A program that fits into the routine of practice by allowing the clinician to easily gather information on the patient's tobacco history, relevant health history, medication history and stage of change/ readiness to quit adheres to Roger's Diffusion of Innovations theory and lends itself to adoption. A major goal of this study is to identify and measure mediating and moderating effects of the CDSS. We will use contextual inquiry with multiple evaluation methods to assess dentist practice preferences and dental office workflow integration. We propose a two-phase development process for definition, usability testing, and clinical testing. A manual of operations will be developed and updated throughout the study. In Phase 1 the DEN-TC system will be developed and defined and we will validity test the DEN-TC within dental offices and perform initial clinical testing with patients. In Phase 2 we will pilot test the DEN-TC intervention in general dental practices to guide the development of a large-scale trial. The proposed project is significant in that, if found to be successful, a Den-TC I-Pad such as the one proposed, could enhance adoption of the USPHS 5A's guidelines in dental practices; innovative because it uses iPads and the Apple platform to directly address provider reluctance to embrace and adopt the 5 A's guidelines for their tobacco using patients; uses a sound scientific approach that is based on previous research; and brings together an experienced team of investigators in an environment that is uniquely suited to the successful completion of the project