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| ID | Type | Description | Link |
|---|---|---|---|
| 4UH3DE030531-03 | U.S. NIH Grant/Contract | View source | |
| A195010 | Other Identifier | UW Madison | |
| 2024-1086 | Other Identifier | Previous IRB number |
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| Name | Class |
|---|---|
| National Institute of Dental and Craniofacial Research (NIDCR) | NIH |
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The goal of this study is to compare different no-show interventions in dental clinics serving underserved populations. The main question it seeks to answer is
Participants will be asked to
Persistent no-show rates contribute to the oral health disparities and inadequate access to dental care that disproportionately affect underserved populations. The proposed research will test the impact of three different strategies on improving show rates using a full factorial design. Specifically, the study is designed as a 2×2×2 factorial cluster-randomized trial of reminder messaging, motivation-enhanced communication, and walk-in visit. The unit of intervention and randomization will be dental clinic sites (clusters). Forty clinics will be randomized between eight possible combinations of receiving or not receiving the three study interventions, with five clinics receiving each intervention. Findings from this study seek to provide an evidence-based approach to reducing no-shows and increasing access to dental care for underserved populations.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | No Intervention | ||
| Reminder Messages | Active Comparator |
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| Walk-in Visits | Active Comparator |
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| Motivation-enhanced Communication | Active Comparator |
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| Reminder Messages & Walk-in visits | Active Comparator |
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| Reminder Messages & Motivation-enhanced Communication | Active Comparator |
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| Walk-in visits & Motivation-enhanced Communication | Active Comparator |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Reminder Messages | Behavioral | Dental clinic staff will use scripts to contact patients 24 and 48 hours before appointments. These scripts will guide staff in confirming the patient will appear for their appointment. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in proportion of scheduled appointments for which the patient attends, pre-to-post intervention | To test the efficacy of motivation-enhanced communication, reminder messaging, and walk-in visits as compared to treatment as usual For each of the three interventions, the pre-to-post intervention change in show rates. Show rate is defined as the proportion of scheduled appointments for which the patient attends their scheduled clinic appointment. Appointments cancelled or rescheduled more than 24 hours in advance are not included in the calculation. Outcome will be measured by data exported from the clinical electronic health records monthly. | 6 months pre-intervention to 12 months post-intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Organizational Change Manager (OCM) Score | To examine whether Organizational Readiness for Change moderates the efficacy of the targeted evidence-based practices. Organizational readiness for change will be assessed by a validated 16-item index called the Organizational Change Manager (OCM) For each clinic site, a group of 5 people that includes clinicians, dental hygienists, manager, and scheduler each team member will provide their own OCM responses. Outcome will be measured by combined responses to Organizational Change Manager survey tool. Total possible ranges of scores will be 0-104, with a higher score indicating increased readiness. The responses to the Organizational Change Manager survey from each clinic staff respondent will be added and an average of those scores will be calculated. |
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Inclusion Criteria:
Sites must be:
Staff must be:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Todd Molfenter, PhD | University of Wisconsin, Madison | Principal Investigator |
| Chris Okunseri, BDS, MSc, MLS, DDPHRCSE | Marquette University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Wisconsin - Madison | Madison | Wisconsin | 53705 | United States |
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The study uses a 2x2x2 factorial cluster-randomized design The unit of intervention and randomization will be dental clinic sites (clusters). Forty clinics will be randomized between eight possible combinations of receiving or not receiving the three study interventions. The factorial structure of the design ensures that 20 clinic sites receive each intervention, and 20 do not. Five clinic sites will receive none of the interventions, five clinics will receive all three interventions, and 30 clinic sites will receive a different combination of 2 of the 3 interventions.
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| Reminder Messages, Walk-in visits, & Motivation-enhanced Communication | Active Comparator |
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| Walk-in Visits | Behavioral | When contacting patients to schedule an appointment (by phone, email, text, or other methods), dental clinic staff will notify patients of times during which patients can walk-in for a dental visit, if convenient for them; otherwise, a regular appointment will be arranged. Scheduled appointments will continue to be available in addition to the walk-in hours. |
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| Motivation-enhanced Communication | Behavioral | Participating clinic site staff will be trained in motivation-enhanced communication techniques using the guide for dental clinic sites and coaching. Topics to be included in the motivation-enhanced communication training are a) to determine what patients hope to gain from their dental care, steps needed to succeed, how the agency and client will work together to attain the goals, and b) to identify patient barriers to attending their visit (e.g., transportation, payment, do not understand need for visit, etc.), and what the agency and patient will do to overcome those barriers. Staff will be instructed to use these techniques with patients at every contact about an upcoming appointment. |
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| Survey will be administered at 3 months |
| Statistical Comparison of Interventions for Effectiveness Analysis | Evaluate the efficacy of motivation-enhanced communication, reminder messaging, and walk-in visits compared to each other. Comparative effectiveness analyses: Evaluate the efficacy of motivation-enhanced communication, reminder messaging, and walk-in visits compared to each other For each of the interventions, the difference in the pre-to-post intervention change in show rates in clinics receiving the different interventions Outcomes will be measured by data exported from the clinical electronic health records monthly. | 6 months pre-intervention to 12 months post-intervention |
| Statistical Comparison of Combining Multiple Interventions for Interaction Analysis | Evaluate the synergy of combining multiple interventions. For each pair of interventions, the difference in the pre-to-post intervention change in show rates in clinics receiving both interventions compared to clinics receiving only one of them. Outcomes will be measured by data exported from the clinical electronic health records monthly. | 6 months pre-intervention to 12 months post-intervention |