An Emergency Department (ED) Provider Centered Intervention for Non-Traumatic Dental Condition Management (NTDC)

University of Florida60 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

Conditions

Emergency Department Visit Odontalgia

Interventions

Clinical decision support toolBEHAVIORAL

The intervention involves two strategies. The first strategy is education where at baseline participants will complete the one-hour online Smiles for Life oral health educational module on acute dental problems, which includes NTDC management. This module can be completed in multiple sessions. Providers will be asked to share the certificate of completion that is provided to them via the website by passing a post knowledge test. The second strategy is CDST. Providers who completed NTDC module certificate will pilot test the CDST which is an algorithm that walks the ED provider thru patient's signs and symptoms and identifies guideline-recommended treatments available in the ED.

Outcomes

Primary Outcomes

Acceptability and feasibility

Using qualitative methods, we will evaluate acceptability using the Theoretical Framework for Acceptability (TFA). Participants will complete a structured interview about acceptability at baseline and after 6 months of use, which should be sufficient time for providers to treat 5-10 patients for whom the tool is applicable. We pre-specify the criteria to define feasibility using criteria adapted from the NIH. Monthly during the trial, providers will answer feasibility surveys, using a web-based tool (i.e, RedCap) distributed via email. We will follow up with non-responders via text message, phone, or in-person. Providers will be offered a $5 gift card per survey as an incentive. To fully assess the impact of our intervention, we pre-specified a high retention rate as key to inform feasibility and effectiveness of future large-scale trials. We will consider successful implementation if \>50% of providers intend to continue using the NTDC CDST postpilot.

Time frame: at baseline, and up to 6 months

Secondary Outcomes

Prescribing behavior

For each participant, we will collect baseline antibiotic and opioid prescribing rates (per ED visit) for NTDC 6 months prior to the intervention from the EHR using the UPMC data analytics tool. All ED prescriptions in our system are created electronically, allowing precise capture of actual provider behavior. We will compare opioid and antibiotic prescribing for NTDC by providers before and after the intervention. To control for secular changes in prescribing, we will compare prescribing by participants during the same 6 months to prescribing by UPMC peers who did not receive the intervention.