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

项目摘要 这项NIDCR双牙医科学家独立之路奖(K99/R00)授予Tumader Khouja BDS mph 博士，将使Khouja博士成为一名独立的口腔健康服务研究员，开发和 实施基于证据的干预措施，将牙科护理整合到医疗环境中，利用 定性与定量相结合的研究方法。这一长期目标将通过5年的培训和 研究计划，将启动Khouja博士的独立研究、学术生涯和支持计划 NIDCR的使命是增加和保持一批新的和有才华的独立双学位 牙医科学家。该计划的职业目标是：(1)干预科学[和生物医学]方面的培训 信息学]；(2)获得定性方法方面的专业知识，以便在理论上提供信息、设计和评估 行为干预，以及(3)作为独立研究者的专业发展。这些职业目标 将通过正式的课程、培训、国家会议、指导和研究经验来实现。 本提案的总体目标是了解非创伤性牙科的障碍和促进者 通过定量和定性的方法对急诊科的病情(NTDC)进行管理。 第一个目标将确定急诊科和随后的急诊科/急救中心处方的国家差异 在急诊科就诊后30天内复诊和住院。使用国家电子健康记录和 集成索赔数据集和随机影响模型，我们将确定与处方相关的因素 在患者、提供者、医院和州一级的NTDC和变异。第二个目标是确定教育提供者的 教育署管理非专利发展中心的障碍及推动者。采用个人深度访谈， ED提供者(医生、高级实践提供者)将确定管理的促进者和障碍 在急诊室给NTDC开处方。第三个目标将试验和改进NTDC的多方面方法 在教育署开出处方，并评估教育署推行这项策略的可接受性和可行性 设置。我们将开发一种两级干预策略[使用以人为中心的设计方法]，这将有助于 根据我们从以前的目标和现场经验中得出的结论，NTDC中的ED提供者对其进行处方和改进。 当我们在ED中测试干预时，我们将使用[匹兹堡大学医学中心的EHR数据 (UPMC)]评估适当的治疗和临床医生在使用ED治疗NTDC之前和期间的经验 干预行动。进一步的试验将测试U级和/或R级提案中干预的有效性。一个 优秀的跨专业团队由一名公共卫生牙医、药剂师、急诊科医生、行为学 心理学家、生物统计学家[和生物医学信息学家]将提供指导以确保这项工作的成功 项目。这项研究计划的长期目标是开发一种可推广和可持续的 干预措施，以改善急诊科和其他医疗机构的NTDC管理。[这项工作支持以下优先事项 美国卫生局局长、NIH主任和NIDCR通过以下方式将口腔健康和全身健康结合起来 建立协作联盟，建立临床医生口腔健康研究人员的多样化渠道。]

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.]