64024
document
Dentists United to Extinguish Tobacco ( DUET ) : a study protocol for a cluster randomized , controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings . BACKGROUND Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions , dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence . METHODS/DESIGN Guided by a multi-level , conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery , the current protocol will use a cluster , randomized design and multiple data sources ( patient exit interviews , provider surveys , site observations , chart audits , and semi-structured provider interviews ) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City . The specific aims of this comparative-effectiveness research trial are to : compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines-staff training and current best practices ( CBP ) , CBP + provider performance feedback ( PF ) , and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment ( pay-for-performance , or P4P ) ; examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation ; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics . The primary outcome is change in providers ' tobacco treatment practices and the secondary outcomes are cost per quit , use of tobacco cessation treatments , quit attempts , and smoking abstinence . DISCUSSION We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies ( CBP , PF , and P4P ) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers . The findings will improve knowledge pertinent to the implementation , dissemination , and sustained utilization of evidence-based tobacco use treatment in dental practices . TRIAL REGISTRATION NCT01615237 .
64025
Intervention_Educational
clinical practice guidelines
64026
Outcome_Other
comparative-effectiveness
64027
Participant_Condition
tobacco dependence
64028
Participant_Condition
smokers
64029
Participant_Condition
tobacco use and dependence
64030
Participant_Sample-size
18