Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Implementing Tobacco Use Treatment Guidelines in Dental Public Health Clinics
Brief Summary: System level strategies for implementing tobacco use treatment guidelines exist but are insufficiently put into practice, particularly in dental care settings. Closing the gap between research and practice is stymied by the limited research on systems changes necessary to implement tobacco treatment in routine dental care. Drawing from a burgeoning dissemination science literature, the proposed study compares the cumulative benefit of the following three systems-level strategies: 1) staff training and clinical reminders, 2) provider feedback and 3) pay-for- performance (financial incentives), that have been widely endorsed by a 2001 Institute of Medicine Report, "Crossing the Quality Chasm" (IOM 2011) and the 2008 PHS Guidelines (Fiore 2007, Fiore 2008, IOM 2011).

The investigators propose a 3-arm cluster randomized controlled trial that will analyze the implementation process and compare the cost and effectiveness of three implementation strategies: 1) Staff training and CBP in implementing PHS Guidelines; 2) CBP + provider performance feedback (PF) and 3) CBP + PF + Pay-for-performance (provider reimbursement for tobacco cessation treatment delivery). Guided by Organizational Change Theory and the Theory of Planned Behavior (Ajzen 1991, Damschroder 2009, Greenhalgh 2004, Solberg 2007) the investigators will identify multi-level factors that facilitate or impede the implementation process in dental clinics. Our primary outcome is improvement in provider delivery of tobacco cessation treatment found through extensive meta-analysis (Fiore 2008) to be an essential determinant of patient cessation outcomes. Our secondary outcome will be post-intervention patient-reported quit rates. In addition to examining the comparative effectiveness of the three implementation strategies, the investigators will use a mixed methods approach to examine implementation processes (Aim 2) to assess the degree to which the interventions are integrated into practice as intended and to clarify the mechanisms through which the intervention influences provider behavior.


Options:
A: Arm Label: CBP + PF; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Audit and performance feedback (PF), Behavioral: Current Best Practices (CBP) | Arm Label: CBP + PF + P4P; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Audit and performance feedback (PF), Behavioral: Financial Incentive (P4P), Behavioral: Current Best Practices (CBP) | Arm Label: Current Best Practices (CBP); Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Current Best Practices (CBP) | Intervention Type: BEHAVIORAL; Name: Audit and performance feedback (PF); Assigned to Arm(s): CBP + PF, CBP + PF + P4P | Intervention Type: BEHAVIORAL; Name: Financial Incentive (P4P); Assigned to Arm(s): CBP + PF + P4P | Intervention Type: BEHAVIORAL; Name: Current Best Practices (CBP); Assigned to Arm(s): CBP + PF, CBP + PF + P4P, Current Best Practices (CBP)
B: Arm Label: Standard Care (SC); Type: EXPERIMENTAL; Interventions: Behavioral: Standard Care (SC) | Arm Label: Intensive Counseling (IC); Type: EXPERIMENTAL; Interventions: Behavioral: Intensive Counseling (IC) | Intervention Type: BEHAVIORAL; Name: Standard Care (SC); Assigned to Arm(s): Standard Care (SC) | Intervention Type: BEHAVIORAL; Name: Intensive Counseling (IC); Assigned to Arm(s): Intensive Counseling (IC)
C: Arm Label: patch; Type: ACTIVE_COMPARATOR; Interventions: Drug: nicotine patch | Arm Label: nicotine lozenge; Type: ACTIVE_COMPARATOR; Interventions: Drug: nicotine lozenge | Arm Label: bupropion; Type: ACTIVE_COMPARATOR; Interventions: Drug: bupropion | Arm Label: patch + lozenge; Type: ACTIVE_COMPARATOR; Interventions: Drug: patch + lozenge | Arm Label: buproion + lozenge; Type: ACTIVE_COMPARATOR; Interventions: Drug: bupropion + lozenge | Intervention Type: DRUG; Name: nicotine patch; Assigned to Arm(s): patch | Intervention Type: DRUG; Name: nicotine patch; Assigned to Arm(s): patch | Intervention Type: DRUG; Name: nicotine lozenge; Assigned to Arm(s): nicotine lozenge | Intervention Type: DRUG; Name: bupropion; Assigned to Arm(s): bupropion | Intervention Type: DRUG; Name: patch + lozenge; Assigned to Arm(s): patch + lozenge | Intervention Type: DRUG; Name: bupropion + lozenge; Assigned to Arm(s): buproion + lozenge
D: Arm Label: High reinforcement cessation program; Type: EXPERIMENTAL; Interventions: Behavioral: high reinforcement cessation program | Arm Label: Low reinforcement cessation program; Type: EXPERIMENTAL; Interventions: Behavioral: low reinforcement cessation program | Intervention Type: BEHAVIORAL; Name: high reinforcement cessation program; Assigned to Arm(s): High reinforcement cessation program | Intervention Type: BEHAVIORAL; Name: low reinforcement cessation program; Assigned to Arm(s): Low reinforcement cessation program

Answer: A