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: Implementation of intervention; Type: EXPERIMENTAL; Interventions: Behavioral: Training in smoking cessation counseling | Arm Label: No implementation of the intervention; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: Training in smoking cessation counseling; Assigned to Arm(s): Implementation of intervention
B: Intervention Type: BEHAVIORAL; Name: smoking cessation intervention; Assigned to Arm(s): N/A | Intervention Type: OTHER; Name: cancer prevention; Assigned to Arm(s): N/A | Intervention Type: OTHER; Name: counseling intervention; Assigned to Arm(s): N/A | Intervention Type: OTHER; Name: educational intervention; Assigned to Arm(s): N/A | Intervention Type: OTHER; Name: laboratory biomarker analysis; Assigned to Arm(s): N/A | Intervention Type: OTHER; Name: questionnaire administration; Assigned to Arm(s): N/A | Intervention Type: OTHER; Name: survey administration; Assigned to Arm(s): N/A | Intervention Type: PROCEDURE; Name: study of high risk factors; Assigned to Arm(s): N/A
C: Intervention Type: BEHAVIORAL; Name: Advice; Assigned to Arm(s): N/A | Intervention Type: BEHAVIORAL; Name: Motivational Interviewing; Assigned to Arm(s): N/A | Intervention Type: DRUG; Name: Nicotine Gum and Patch; Assigned to Arm(s): N/A | Intervention Type: DRUG; Name: Bupropion; Assigned to Arm(s): N/A
D: 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)

Answer: D