Pit-and-Fissure Sealants
Conditions
Keywords
evidence-based clinical practice guideline, dental sealants, Deliberative Democracy, Deliberative Loop
Brief summary
The purpose of this implementation science study is to determine whether Deliberative Loops are effective in increasing providers' adherence to the non-cavitated caries component of the American Dental Association's pit-and-fissure sealant evidence-based clinical practice guideline. The investigators use a stepped wedge design to randomly assign dental clinics to the Deliberative Loop intervention. In a Deliberative Loop, stakeholders receive background information, participate in a facilitated discussion, and share their views with leadership. The Deliberative Loop intervention is designed to help stakeholders form informed opinions; in this study, stakeholders will be forming informed opinions about the implementation interventions they think will increase their clinic's adherence to the guideline. The investigators hypothesize that compared with the pre-intervention period, following the intervention, providers will place or treatment plan sealants for significantly more occlusal non-cavitated carious lesions.
Detailed description
The purpose of this implementation science study is to determine whether Deliberative Loops are effective in increasing providers' adherence to the non-cavitated caries component of the American Dental Association's pit-and-fissure sealant evidence-based clinical practice guideline. The investigators use a stepped wedge design to randomly assign dental clinics to the Deliberative Loop intervention. In a Deliberative Loop, stakeholders receive background information, participate in a facilitated discussion, and share their views with leadership. The Deliberative Loop intervention is designed to help stakeholders form informed opinions; in this study, stakeholders will be forming informed opinions about the implementation interventions they think will increase their clinic's adherence to the guideline. The investigators hypothesize that compared with the pre-intervention period, following the intervention, providers will place or treatment plan sealants for significantly more occlusal non-cavitated carious lesions (NCCL). All persons employed by Kaiser Permanente Northwest or Permanente Dental Associates and who work in a Kaiser Permanente Northwest dental clinic at any level \[e.g., part time, full time\] will be eligible to participate in the study. This includes both service providers and front-of-the-house staff, approximately 1,200 employees. This is a Stage III study. Participating sites include the 16 general dental clinics of Kaiser Permanente Northwest. All clinics are located within the United States. The estimated time from when the study opens to enrollment until completion of data collection is 16 months. It will take approximately one to two months for each individual participant to complete all study-related tasks, depending on how soon after the introductory session the Deliberative session can be scheduled.
Interventions
BEHAVIORALDeliberative Loop
The investigators will give background information to the stakeholders before they engage in the Deliberative session. Stakeholders from a given clinic will come together for a Deliberative session (i.e., facilitated conversation), enabling them to hear the full range of perspectives held by their fellow colleagues and to share their own perspective regarding how best to implement the guideline in small-group discussions. Following the Deliberative session, each stakeholder will have the opportunity to record their opinions regarding possible implementation interventions. The investigators will share these opinions with the clinic's decision-makers to help guide their decision-making about which implementation interventions to deploy. If a stakeholder happens to be absent the day of their clinic's Deliberative session, they will still have the opportunity to complete the survey.
Sponsors
National Institute of Dental and Craniofacial Research (NIDCR)
Kaiser Permanente
University of Pittsburgh
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Stepped wedge. In addition to the vanguard clinic, there will be five steps, each with three clinics.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Employed by Kaiser Permanente Northwest Dental or Permanente Dental Associates * Work in a Kaiser Permanente Northwest dental clinic
Exclusion criteria
* none
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Providers' Rates of Placing or Treatment Planning Sealants for Occlusal NCCLs | from one month before the first step to two months after the final step, 1 year. | The change in the providers' rates of placing or treatment planning sealants for occlusal NCCLs from before to after clinic stakeholders are exposed to the Deliberative Loop intervention |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total Program Costs | from planning the survey to gather background information to two months after the final step; an average of 1 year | Program costs: Total intervention costs. Program cost analysis conducted for the Deliberative Loop (DL) intervention using an opportunity cost approach. Program costs were estimated for the DL intervention (Workbook development - including the guideline, EHR data analyses, initial practitioner survey, and evidence review - and printing; Online DL session facilitator training and delivery, and program tailoring; dental office staff time; costs for implemented strategies, if applicable; and allowed charges for dental sealant placements). All costs are reported in 2021 dollars. The study analysis period was Jan 1-Dec 31, 2021, and in 16 clinics during 2021. |
| Cost Per Clinic | from planning the survey to gather background information to two months after the final step; an average of 1 year | Program costs: Cost per clinic |
| Cost Per Member Per Month (PMPM) | from planning the survey to gather background information to two months after the final step; an average of 1 year | Total intervention costs per member per month. Program cost analysis conducted for the Deliberative Loop (DL) intervention using an opportunity cost approach. Program costs were estimated for the DL intervention (Workbook development - including the guideline, EHR data analyses, initial practitioner survey, and evidence review - and printing; Online DL session facilitator training and delivery, and program tailoring; dental office staff time; costs for implemented strategies, if applicable; and allowed charges for dental sealant placements). All costs are reported in 2021 dollars. The study analysis period was Jan 1-Dec 31, 2021, and in 16 clinics during 2021. There were 265,200 members age 6 years or more on January 1, 2021, or a total of 3,182,400 member months. |
| Annualized Costs for Guideline Implementation Interventions | from planning the survey to gather background information to two months after the final step; an average of 1 year | Program costs: Annualized costs for guideline implementation interventions |
| Sealant Treatment Plan Resolution | when a clinic was exposed to the intervention (when they received their survey results) to December 31, 2021. (Vanguard- 9.34 months; Cluster 1- 7.84 months; Cluster 2- 6.39 months; Cluster 3- 5.30 months; Cluster 4- 3.33 months; Cluster 5- 2.75 months) | The count of occlusal NCCLs with a treatment plan for sealants that is sealed by the end of the post-intervention evaluation period. |
| NCCL Treatment Costs- Total Program Costs Per Sealant Per Clinic | from planning the survey to gather background information to two months after the final step; an average of 1 year | Program costs: NCCL treatment costs- Total program costs per sealant per clinic |
| NCCL Treatment Costs- Per Sealant Per Member Per Month (PMPM) | from planning the survey to gather background information to two months after the final step; an average of 1 year | Total intervention costs per sealant per member per month. Program cost analysis conducted for the Deliberative Loop (DL) intervention using an opportunity cost approach. Program costs were estimated for the DL intervention (Workbook development - including the guideline, EHR data analyses, initial practitioner survey, and evidence review - and printing; Online DL session facilitator training and delivery, and program tailoring; dental office staff time; costs for implemented strategies, if applicable; and allowed charges for dental sealant placements). All costs are reported in 2021 dollars. The study analysis period was Jan 1-Dec 31, 2021, and in 16 clinics during 2021. There were 95 sealants placed during the intervention period at 16 clinics. There were 265,200 members age 6 years or more on January 1, 2021, or a total of 3,182,400 member months. |
| Cost Effectiveness | from one month before the first step to two months after the final step, 1 year | Estimated incremental cost-effectiveness ratios (ICERs) for clinics after exposure to the intervention. ICERs calculated for annualized total costs, costs per clinic, and costs PMPM. |
| NCCL Treatment Costs- Total Program Costs Per Sealant | from planning the survey to gather background information to two months after the final step; an average of 1 year | Total intervention costs per sealant. Program cost analysis conducted for the Deliberative Loop (DL) intervention using an opportunity cost approach. Program costs were estimated for the DL intervention (Workbook development - including the guideline, EHR data analyses, initial practitioner survey, and evidence review - and printing; Online DL session facilitator training and delivery, and program tailoring; dental office staff time; costs for implemented strategies, if applicable; and allowed charges for dental sealant placements). All costs are reported in 2021 dollars. The study analysis period was Jan 1-Dec 31, 2021, and in 16 clinics during 2021. There were 95 sealants placed during the intervention period at 16 clinics. |
Other
| Measure | Time frame | Description |
|---|---|---|
| List of Implementation Strategies Endorsed by Stakeholders | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' informed opinion about what implementation strategies their clinic should adopt for each barrier |
| List of Barriers Perceived by Stakeholders | One survey was available for participants to complete immediately following the DL session and the survey stayed available for 1 week following the session. | Stakeholders' informed opinion about barriers they perceive in their clinic |
| Acceptability, Management - Deliberative Loop Process | A single assessment following completion of all data analyses, approximately 1.5 years after the data collection end date. | management's perceptions of the acceptability of the Deliberative Loop process measured on a 5-point Likert scale, 0=not at all acceptable to 4=completely acceptable These ratings were dependent upon having all other analyses completed. |
| List of Implementation Strategies Adopted by the Clinics, Qualitative | 3 months after receiving the clinic summary report | qualitative interviews of clinic staff, using the quantitative forms as the basis for the interview |
| List of Implementation Strategies Adopted by the Clinics, Quantitative | 3 months after receiving the clinic summary report | List of implementation strategies. Clinic staff can select strategies on the list that their clinic has adopted to document progress of the implementation process |
| Acceptability, Stakeholders - Deliberative Loop Process | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' perceptions of the acceptability of the Deliberative Loop process, 1 question, 5-point Likert scale, 0=Strongly Disagree, 4=Strongly Agree A higher score means more acceptability. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care. |
| Acceptability, Stakeholders - Context Setting Document | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' perceptions of the acceptability of the Context-Setting Document, 3 questions measured on a 5-point Likert scale, 0=Strongly disagree to 12=Strongly agree. Note - Each item is 0 to 4, and the total score ranges from 0 - 12. A higher score means more acceptability. |
| Helpfulness of Group Discussion | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' perceptions of helpfulness of group discussion measured on a 3 question, 5-point Likert scale, 0=Strongly disagree to 12=Strongly agree. Note - Each item is 0 to 4, and the total score ranges from 0 - 12. A higher score means more helpfulness. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care. |
| Promotive Voice | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' perceptions of ability to express new ideas or suggestions for improving the clinic, 5 questions, 5-point Likert scale. Note - Each item is 0 to 4, and the total score ranges from 0-20, 0=Strongly disagree to 20=Strongly agree. A higher score means more promotive voice. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care. |
| Prohibitive Voice | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' perceptions of ability to express concern about work practices that may be harmful to the clinic, 5 questions, 5-point Likert scale. Note - Each item is 0 to 4, and the total score ranges from 0-20, 0=Strongly disagree to 20=Strongly agree. A higher score means more prohibitive voice. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care. |
| Future Leadership Responsiveness | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' perceptions that suggestions will be taken into consideration by leadership, 1 item, 5-point Likert scale, 0=Strongly disagree to 4=Strongly agree A higher score means more leadership responsiveness. |
| Past Leadership Responsiveness | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' perceptions that suggestions have been taken into consideration by leadership in the past, 2 questions, 5-point Likert scale. Note - Each item is 0 to 4, and the total score ranges from 0-8, 0=Strongly disagree to 8=Strongly agree. A higher score means more stakeholder perception of leadership responsiveness. |
| Overall Voice | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' perceptions of voice, 1 question, 5-point Likert scale, 0=Strongly disagree to 4=Strongly agree A higher score means more overall voice. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care. |
| Perceptions of Discussion | One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session. | Stakeholders' perceptions about the discussion, 2 questions, 5-point Likert scale. Note - Each item is 0 to 4, and the total score ranges from 0 - 8, 0=Strongly disagree to 8=Strongly agree. A higher score means more consideration of important issues and points of view. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care. |
Countries
United States
Participant flow
Recruitment details
All providers and staff at 16 intervention clinics at Kaiser Permanente (KP). Overall study - January 1, 2021 - December 31, 2021
Pre-assignment details
This is a stepped wedge cluster randomized trial where dental clinics were randomized to the Deliberative Loop intervention. Clinics were randomized to one of five intervention periods. We randomized three clinics at a time. The goal was to have a six-week window in which to run the three clinics that are in a given step and then a week gap before the next step's six-week window starts.
Participants by arm
| Arm | Count |
|---|---|
| Study Participants - Deliberative Loop 28-page Context-Setting Document; 2-page addendum to Context-Setting Document; 90 minute Deliberative session; 8-page post-session survey
Deliberative Loop: The investigators will give background information to the stakeholders before they engage in the Deliberative session. Stakeholders from a given clinic will come together for a Deliberative session (i.e., facilitated conversation), enabling them to hear the full range of perspectives held by their fellow colleagues and to share their own perspective regarding how best to implement the guideline in small-group discussions.
Following the Deliberative session, each stakeholder will have the opportunity to record their opinions regarding possible implementation interventions. The investigators will share these opinions with the clinic's decision-makers to help guide their decision-making about which implementation interventions to deploy. If a stakeholder happens to be absent the day of their clinic's Deliberative session, they will still have the opportunity to complete the survey. | 680 |
| Study Participants - Deliberative Loop 28-page Context-Setting Document; 2-page addendum to Context-Setting Document; 90 minute Deliberative session; 8-page post-session survey
Deliberative Loop: The investigators will give background information to the stakeholders before they engage in the Deliberative session. Stakeholders from a given clinic will come together for a Deliberative session (i.e., facilitated conversation), enabling them to hear the full range of perspectives held by their fellow colleagues and to share their own perspective regarding how best to implement the guideline in small-group discussions.
Following the Deliberative session, each stakeholder will have the opportunity to record their opinions regarding possible implementation interventions. The investigators will share these opinions with the clinic's decision-makers to help guide their decision-making about which implementation interventions to deploy. If a stakeholder happens to be absent the day of their clinic's Deliberative session, they will still have the opportunity to complete the survey. | 5,983 |
| Total | 6,663 |
Baseline characteristics
| Characteristic | Study Participants - Deliberative Loop |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 9 Participants |
| Age, Categorical Between 18 and 65 years | 671 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 45 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 635 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Provider rate of placing or treatment planning sealants for occlusal NCCLs | 137 Teeth |
| Race (NIH/OMB) American Indian or Alaska Native | 13 Participants |
| Race (NIH/OMB) Asian | 97 Participants |
| Race (NIH/OMB) Black or African American | 26 Participants |
| Race (NIH/OMB) More than one race | 8 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 6 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 10 Participants |
| Race (NIH/OMB) White | 520 Participants |
| Region of Enrollment United States | 680 participants |
| Sex: Female, Male Female | 549 Participants |
| Sex: Female, Male Male | 131 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Change in Providers' Rates of Placing or Treatment Planning Sealants for Occlusal NCCLs
The change in the providers' rates of placing or treatment planning sealants for occlusal NCCLs from before to after clinic stakeholders are exposed to the Deliberative Loop intervention
Time frame: from one month before the first step to two months after the final step, 1 year.
Population: The study participants are dental providers/staff. However, our primary outcome measured the change in the dental providers' rates of placing or treatment planning sealants for occlusal NCCLs from before to after clinic stakeholders are exposed to the Deliberative Loop intervention. Therefore, the units analyzed were teeth of the providers' patients. The number of participant providers that apply to the 9600 teeth is not available.
| Arm | Measure | Group | Value (COUNT_OF_UNITS) |
|---|---|---|---|
| Deliberative Loop | Change in Providers' Rates of Placing or Treatment Planning Sealants for Occlusal NCCLs | Pre-intervention | 137 Teeth |
| Deliberative Loop | Change in Providers' Rates of Placing or Treatment Planning Sealants for Occlusal NCCLs | Post-intervention | 95 Teeth |
p-value: 0.1895% CI: [0.58, 1.11]Mixed Models Analysis
Secondary
Annualized Costs for Guideline Implementation Interventions
Program costs: Annualized costs for guideline implementation interventions
Time frame: from planning the survey to gather background information to two months after the final step; an average of 1 year
Population: KPNW Dental System. All costs reported are automatically annualized. Originally we thought the intervention would cross calendar years. Since the intervention took place entirely in 2021, it is automatically annualized.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Deliberative Loop | Annualized Costs for Guideline Implementation Interventions | 125,521 dollars |
Secondary
Cost Effectiveness
Estimated incremental cost-effectiveness ratios (ICERs) for clinics after exposure to the intervention. ICERs calculated for annualized total costs, costs per clinic, and costs PMPM.
Time frame: from one month before the first step to two months after the final step, 1 year
Population: Cost-effectiveness analyses are not conducted for interventions that are found to be ineffective compared to controls. Therefore, measure could not be assessed due to the results of the primary outcome measure.
Secondary
Cost Per Clinic
Program costs: Cost per clinic
Time frame: from planning the survey to gather background information to two months after the final step; an average of 1 year
Population: 16 dental clinics
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Deliberative Loop | Cost Per Clinic | 7845 dollars per clinic |
Comparison: Mean Total Program costs per clinic for the KPNW Dental system.95% CI: [6378, 9312]
Secondary
Cost Per Member Per Month (PMPM)
Total intervention costs per member per month. Program cost analysis conducted for the Deliberative Loop (DL) intervention using an opportunity cost approach. Program costs were estimated for the DL intervention (Workbook development - including the guideline, EHR data analyses, initial practitioner survey, and evidence review - and printing; Online DL session facilitator training and delivery, and program tailoring; dental office staff time; costs for implemented strategies, if applicable; and allowed charges for dental sealant placements). All costs are reported in 2021 dollars. The study analysis period was Jan 1-Dec 31, 2021, and in 16 clinics during 2021. There were 265,200 members age 6 years or more on January 1, 2021, or a total of 3,182,400 member months.
Time frame: from planning the survey to gather background information to two months after the final step; an average of 1 year
Population: 265,200 members age 6 yrs or more on January 1, 2021 x 12 months.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Deliberative Loop | Cost Per Member Per Month (PMPM) | 0.039 dollars per member per month |
Secondary
NCCL Treatment Costs- Per Sealant Per Member Per Month (PMPM)
Total intervention costs per sealant per member per month. Program cost analysis conducted for the Deliberative Loop (DL) intervention using an opportunity cost approach. Program costs were estimated for the DL intervention (Workbook development - including the guideline, EHR data analyses, initial practitioner survey, and evidence review - and printing; Online DL session facilitator training and delivery, and program tailoring; dental office staff time; costs for implemented strategies, if applicable; and allowed charges for dental sealant placements). All costs are reported in 2021 dollars. The study analysis period was Jan 1-Dec 31, 2021, and in 16 clinics during 2021. There were 95 sealants placed during the intervention period at 16 clinics. There were 265,200 members age 6 years or more on January 1, 2021, or a total of 3,182,400 member months.
Time frame: from planning the survey to gather background information to two months after the final step; an average of 1 year
Population: 265,200 members age 6 yrs or more on Jan1, 2021
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Deliberative Loop | NCCL Treatment Costs- Per Sealant Per Member Per Month (PMPM) | 0.0004 dollars per sealant PMPM |
Secondary
NCCL Treatment Costs- Total Program Costs Per Sealant
Total intervention costs per sealant. Program cost analysis conducted for the Deliberative Loop (DL) intervention using an opportunity cost approach. Program costs were estimated for the DL intervention (Workbook development - including the guideline, EHR data analyses, initial practitioner survey, and evidence review - and printing; Online DL session facilitator training and delivery, and program tailoring; dental office staff time; costs for implemented strategies, if applicable; and allowed charges for dental sealant placements). All costs are reported in 2021 dollars. The study analysis period was Jan 1-Dec 31, 2021, and in 16 clinics during 2021. There were 95 sealants placed during the intervention period at 16 clinics.
Time frame: from planning the survey to gather background information to two months after the final step; an average of 1 year
Population: Within KPNW Dental system, teeth receiving a sealant.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Deliberative Loop | NCCL Treatment Costs- Total Program Costs Per Sealant | 1321 dollars per sealant |
Secondary
NCCL Treatment Costs- Total Program Costs Per Sealant Per Clinic
Program costs: NCCL treatment costs- Total program costs per sealant per clinic
Time frame: from planning the survey to gather background information to two months after the final step; an average of 1 year
Population: KPNW Dental System / 16 intervention clinics
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Deliberative Loop | NCCL Treatment Costs- Total Program Costs Per Sealant Per Clinic | 1321 dollars per sealant per clinic |
Comparison: Mean Total Program costs per sealant per clinic for the KPNW Dental system.95% CI: [845, 3208]
Secondary
Sealant Treatment Plan Resolution
The count of occlusal NCCLs with a treatment plan for sealants that is sealed by the end of the post-intervention evaluation period.
Time frame: when a clinic was exposed to the intervention (when they received their survey results) to December 31, 2021. (Vanguard- 9.34 months; Cluster 1- 7.84 months; Cluster 2- 6.39 months; Cluster 3- 5.30 months; Cluster 4- 3.33 months; Cluster 5- 2.75 months)
Population: Teeth with a treatment plan
| Arm | Measure | Value (COUNT_OF_UNITS) |
|---|---|---|
| Deliberative Loop | Sealant Treatment Plan Resolution | 89 Teeth |
Secondary
Total Program Costs
Program costs: Total intervention costs. Program cost analysis conducted for the Deliberative Loop (DL) intervention using an opportunity cost approach. Program costs were estimated for the DL intervention (Workbook development - including the guideline, EHR data analyses, initial practitioner survey, and evidence review - and printing; Online DL session facilitator training and delivery, and program tailoring; dental office staff time; costs for implemented strategies, if applicable; and allowed charges for dental sealant placements). All costs are reported in 2021 dollars. The study analysis period was Jan 1-Dec 31, 2021, and in 16 clinics during 2021.
Time frame: from planning the survey to gather background information to two months after the final step; an average of 1 year
Population: KPNW Dental system
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Deliberative Loop | Total Program Costs | 125,521 dollars |
Other Pre-specified
Acceptability, Management - Deliberative Loop Process
management's perceptions of the acceptability of the Deliberative Loop process measured on a 5-point Likert scale, 0=not at all acceptable to 4=completely acceptable These ratings were dependent upon having all other analyses completed.
Time frame: A single assessment following completion of all data analyses, approximately 1.5 years after the data collection end date.
Population: PDA Dental Director for Evidence Based Practice - this is one person
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Deliberative Loop | Acceptability, Management - Deliberative Loop Process | 1.5 score on a scale |
Other Pre-specified
Acceptability, Stakeholders - Context Setting Document
Stakeholders' perceptions of the acceptability of the Context-Setting Document, 3 questions measured on a 5-point Likert scale, 0=Strongly disagree to 12=Strongly agree. Note - Each item is 0 to 4, and the total score ranges from 0 - 12. A higher score means more acceptability.
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Population: Post deliberative loop session survey respondents.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Deliberative Loop | Acceptability, Stakeholders - Context Setting Document | 6.4 score on a scale | Standard Deviation 3 |
Other Pre-specified
Acceptability, Stakeholders - Deliberative Loop Process
Stakeholders' perceptions of the acceptability of the Deliberative Loop process, 1 question, 5-point Likert scale, 0=Strongly Disagree, 4=Strongly Agree A higher score means more acceptability. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care.
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Population: Participants in deliberative loop process and UBT process. Same participants.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Deliberative Loop | Acceptability, Stakeholders - Deliberative Loop Process | Deliberative Loop | 1.9 score on a scale | Standard Deviation 1.3 |
| Deliberative Loop | Acceptability, Stakeholders - Deliberative Loop Process | UBT | 2.7 score on a scale | Standard Deviation 1 |
Other Pre-specified
Future Leadership Responsiveness
Stakeholders' perceptions that suggestions will be taken into consideration by leadership, 1 item, 5-point Likert scale, 0=Strongly disagree to 4=Strongly agree A higher score means more leadership responsiveness.
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Population: Participants in deliberative loop session who filled out the post-session survey
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Deliberative Loop | Future Leadership Responsiveness | 2.4 score on a scale | Standard Deviation 1.1 |
Other Pre-specified
Helpfulness of Group Discussion
Stakeholders' perceptions of helpfulness of group discussion measured on a 3 question, 5-point Likert scale, 0=Strongly disagree to 12=Strongly agree. Note - Each item is 0 to 4, and the total score ranges from 0 - 12. A higher score means more helpfulness. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care.
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Population: Participants in both deliberative loop and UBT sessions.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Deliberative Loop | Helpfulness of Group Discussion | Deliberative loop helpfulness | 5.1 score on a scale | Standard Deviation 3 |
| Deliberative Loop | Helpfulness of Group Discussion | UBT helpfulness | 8.3 score on a scale | Standard Deviation 2.3 |
Other Pre-specified
List of Barriers Perceived by Stakeholders
Stakeholders' informed opinion about barriers they perceive in their clinic
Time frame: One survey was available for participants to complete immediately following the DL session and the survey stayed available for 1 week following the session.
Other Pre-specified
List of Implementation Strategies Adopted by the Clinics, Qualitative
qualitative interviews of clinic staff, using the quantitative forms as the basis for the interview
Time frame: 3 months after receiving the clinic summary report
Other Pre-specified
List of Implementation Strategies Adopted by the Clinics, Quantitative
List of implementation strategies. Clinic staff can select strategies on the list that their clinic has adopted to document progress of the implementation process
Time frame: 3 months after receiving the clinic summary report
Other Pre-specified
List of Implementation Strategies Endorsed by Stakeholders
Stakeholders' informed opinion about what implementation strategies their clinic should adopt for each barrier
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Other Pre-specified
Overall Voice
Stakeholders' perceptions of voice, 1 question, 5-point Likert scale, 0=Strongly disagree to 4=Strongly agree A higher score means more overall voice. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care.
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Population: Participants in both deliberative loop and UBT sessions.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Deliberative Loop | Overall Voice | Deliberative Loop Session | 1.9 score on a scale | Standard Deviation 1.3 |
| Deliberative Loop | Overall Voice | UBT Session | 2.7 score on a scale | Standard Deviation 1 |
Other Pre-specified
Past Leadership Responsiveness
Stakeholders' perceptions that suggestions have been taken into consideration by leadership in the past, 2 questions, 5-point Likert scale. Note - Each item is 0 to 4, and the total score ranges from 0-8, 0=Strongly disagree to 8=Strongly agree. A higher score means more stakeholder perception of leadership responsiveness.
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Population: Participants in the deliberative loop session who filled out the post-session survey.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Deliberative Loop | Past Leadership Responsiveness | 4.4 score on a scale | Standard Deviation 2.2 |
Other Pre-specified
Perceptions of Discussion
Stakeholders' perceptions about the discussion, 2 questions, 5-point Likert scale. Note - Each item is 0 to 4, and the total score ranges from 0 - 8, 0=Strongly disagree to 8=Strongly agree. A higher score means more consideration of important issues and points of view. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care.
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Population: Participants in both deliberative loop and UBT sessions
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Deliberative Loop | Perceptions of Discussion | Deliberative Loop Session | 4.1 score on a scale | Standard Deviation 2.2 |
| Deliberative Loop | Perceptions of Discussion | UBT Session | 5.6 score on a scale | Standard Deviation 1.9 |
Other Pre-specified
Prohibitive Voice
Stakeholders' perceptions of ability to express concern about work practices that may be harmful to the clinic, 5 questions, 5-point Likert scale. Note - Each item is 0 to 4, and the total score ranges from 0-20, 0=Strongly disagree to 20=Strongly agree. A higher score means more prohibitive voice. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care.
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Population: Participants in both deliberative loop and UBT sessions. Same participants.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Deliberative Loop | Prohibitive Voice | Deliberative Loop | 10.7 score on a scale | Standard Deviation 5 |
| Deliberative Loop | Prohibitive Voice | UBT | 13.3 score on a scale | Standard Deviation 4.5 |
Other Pre-specified
Promotive Voice
Stakeholders' perceptions of ability to express new ideas or suggestions for improving the clinic, 5 questions, 5-point Likert scale. Note - Each item is 0 to 4, and the total score ranges from 0-20, 0=Strongly disagree to 20=Strongly agree. A higher score means more promotive voice. Note: UBT stands for unit-based team. It is a group of frontline employees, including managers, dental staff (assistants, hygienists), and dentists who work together. UBTs hold regular meetings as part of their standard work flow and collaborate with one another to improve member and patient care.
Time frame: One survey was available for participants to complete immediately following the deliberative loop session and the survey stayed available for 1 week following the deliberative loop session.
Population: Participants in both deliberative loop and UBT sessions.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Deliberative Loop | Promotive Voice | Deliberative Loop | 11.5 score on a scale | Standard Deviation 5.4 |
| Deliberative Loop | Promotive Voice | UBT | 15.4 score on a scale | Standard Deviation 4.3 |