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Organizational Change in Dental Care

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT03367416
Recruitment Status : Active, not recruiting
First Posted : December 8, 2017
Last Update Posted : August 3, 2018
Medical College of Wisconsin
Marquette University
National Institute of Dental and Craniofacial Research (NIDCR)
Information provided by (Responsible Party):
University of Wisconsin, Madison

Brief Summary:

The proposed research will test the ability of the NIATx Organizational Change Model to improve patient no-show rates as compared to typical training approaches used in dental offices. The purpose of the pilot study is to improve no-show rates and, in the process, test an evidence-based organizational change model that can increase use of evidence-based practices in dental care.

NIATx is not an acronym, it is a proper noun.

Condition or disease Intervention/treatment
Patient No Show Behavioral: NIATx model

Detailed Description:

For designing the pilot study, it is assumed that the no-show rates in dental clinics will have similar characteristics and response patterns to previous studies.

The preliminary summary data provided by the participating dental clinics, the current average no-show rate is approximately 20%, which would reduce to 10% using the upper limit of the confidence interval from the preliminary data. Based on a simulation study incorporating the above assumptions, with 5 sites each contributing 160 appointments before and after the intervention, the study will have 84% power to detect the hypothesized effect (OR=0.44) at a two-sided 5% significance level. The probability of observing a decrease in no-show rates in at least 4 out of 5 of the clinics is approximately 90%. We expect over 80 appointments per month in each clinic, so the target number of appointments would be expected to be available in 2-3 months.

For the NIATx Fidelity Scale, if an organization has an average score of 2 or higher on the NIATx Fidelity Scale for 8 of the 13 measures that will be considered significant. In a previous study using a similar process, 73% of the organizations that achieved gains of +10%, had 8 measures or more with an average score of 2 or greater, compared to 40% of those who had gains at <10%.

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Study Type : Observational
Actual Enrollment : 32 participants
Observational Model: Cohort
Time Perspective: Cross-Sectional
Official Title: Test of an Organizational Change Model in Dental Care Settings
Actual Study Start Date : January 1, 2018
Estimated Primary Completion Date : July 2019
Estimated Study Completion Date : August 31, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Dental Health

Group/Cohort Intervention/treatment
This study will test the NIATx model, an evidence-based behavioral intervention for implementing organizational change and quality improvement in community based health settings with a high proportion of underserved individuals. The goal of the study will be to use the model to identify and implement organizational changes in dental practices that will improve the no-show rate in underserved populations.
Behavioral: NIATx model

The NIATx model engages organizations through a multi-clinic learning collaborative and coaching. NIATx teaches organizations how to implement change by using their own organization as the teaching mechanism. Key components of the model include:

  1. educating executives on how to promote effective process change techniques
  2. training staff teams in the theory and practice of organizational change techniques
  3. training staff to develop and implement a process improvement intervention
  4. implementing a sustainability plan to institutionalize change and avoid reverting to previous methods

Primary Outcome Measures :
  1. Analyze clinic data for trends and patterns in patient no-show behaviour. [ Time Frame: 7 months ]
    Data from clinic patient records will be gathered and analyzed to determine the percent of cancelled appointments in a given time period, to detect patterns over time and determine if no-shows are more prevalent with certain populations or procedures.

  2. Staff surveys to test clinic adherence to the components of the NIATx model. [ Time Frame: 7 months ]
    Paper surveys will be used to collect data from clinic staff. Surveys will measure how the clinic conducts organizational change, the degree to which the clinics are using elements of the NIATx model and which proven no-show practices clinics have adopted.

  3. Patient qualitative interviews to assess the patient experience in missing an appointment. [ Time Frame: 2 months ]
    Interviews will be open questions to understand the process from the users point of view. This information will help the study team understand the root causes of patient behaviour and propose model improvements that address these causes.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population

Community dental clinics that:

  • Serve at least a 50 percent minority population
  • Accept a high number of Medicaid patients
  • Are able to provide de-identified clinic data to the research team
  • Are willing to undertake and support an organizational improvement project to decrease no-show rates

Inclusion Criteria:

In order to be eligible to participate in this study, staff must be:

  • 18 or older
  • A paid staff member at a dental clinic participating in the study
  • Willing to participate in the interviews and share their ideas and experiences
  • Involved in an organizational improvement project at a participating clinic
  • Be able and willing to provide verbal consent

Exclusion Criteria:

An individual who does not regularly interact with patients in a dental clinic.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT03367416

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United States, Wisconsin
More Smiles Wisconsin
Madison, Wisconsin, United States, 53703
Community Dental Clinic North-Marquette School of Dentistry
Milwaukee, Wisconsin, United States, 53201
Community Dental Clinic South-Marquette School of Dentistry
Milwaukee, Wisconsin, United States, 53215
Children's Hospital of Wisconsin
Milwaukee, Wisconsin, United States, 53226
Sponsors and Collaborators
University of Wisconsin, Madison
Medical College of Wisconsin
Marquette University
National Institute of Dental and Craniofacial Research (NIDCR)
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Principal Investigator: Todd Molfenter, PhD University of Wisconsin, Madison
Principal Investigator: Christopher Okunseri, BDS Marquette University

Additional Information:
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Responsible Party: University of Wisconsin, Madison Identifier: NCT03367416     History of Changes
Other Study ID Numbers: 2017-1247
U56DE027442 ( U.S. NIH Grant/Contract )
First Posted: December 8, 2017    Key Record Dates
Last Update Posted: August 3, 2018
Last Verified: August 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No