Northridge Mary E, Littlejohn Tina, Mohadjeri-Franck Nathalie, Gargano Steven, Troxel Andrea B, Wu Yinxiang, Bowe Robert B, Testa Paul A
Hansjörg Wyss Department of Plastic Surgery, Division of Dental Medicine, New York University) NYU Grossman School of Medicine, Brooklyn, NY.
Department of Population Health, Division of Biostatistics, NYU Grossman School of Medicine, New York, NY.
J Public Health Res. 2020 May 27;9(1):1777. doi: 10.4081/jphr.2020.1777. eCollection 2020 Jun 4.
Oral cancer remains prevalent, despite being largely preventable. The widespread use of technology at chairside, combined with advances in electronic health record (EHR) capabilities, present opportunities to improve oral cancer screening by dentists, especially for disadvantaged patients with severe health needs. Using a mixed-methods approach, we will evaluate the feasibility and acceptability of integrating a telementoring component into the identification of oral lesions using the following 3 methods: 1) administering provider surveys that consist of a checklist of 10 key components of the intervention based on process, and asking the dental provider subjects if each one was covered; 2) conducting semi-structured interviews informed by the Consolidated Framework for Implementation Research and the Implementation Outcomes Framework with dental resident subjects to assess specific barriers to sustaining the intervention and strategies for addressing these barriers to facilitate integration of the intervention into the routine workflow of the dental clinics; and 3) administering brief exit interviews with patient subjects regarding the acceptability of the intervention to assess satisfaction with the use of intra-oral cameras at chairside to screen for and refer patients with oral lesions and identification of these oral lesions via EHR and secure e-mail tele-mentoring with an oral pathology expert. If successful, then later clinical trials will maximize the external validity of the intervention and facilitate the widespread implementation and dissemination of the model for the teaching of dentists and residents, with the ultimate goal of improving patient care.
尽管口腔癌在很大程度上是可预防的，但它仍然很普遍。椅旁技术的广泛应用，再加上电子健康记录（EHR）功能的进步，为牙医改善口腔癌筛查提供了机会，特别是对于有严重健康需求的弱势患者。我们将采用混合方法，通过以下三种方法评估将远程指导组件整合到口腔病变识别中的可行性和可接受性：1）对医疗服务提供者进行调查，调查内容包括基于流程的干预措施的10个关键组成部分的清单，并询问牙科医疗服务提供者受试者每个部分是否涵盖；2）根据实施研究综合框架和实施结果框架，对牙科住院医师受试者进行半结构化访谈，以评估维持干预措施的具体障碍以及解决这些障碍的策略，以便于将干预措施整合到牙科诊所的常规工作流程中；3）对患者受试者进行简短的退出访谈，了解干预措施的可接受性，以评估对在椅旁使用口腔内摄像头筛查和转诊口腔病变患者以及通过EHR和与口腔病理专家进行安全电子邮件远程指导来识别这些口腔病变的满意度。如果成功，那么后续的临床试验将使干预措施的外部有效性最大化，并促进该模式在牙医和住院医师教学中的广泛实施和传播，最终目标是改善患者护理。
