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Pit-and-Fissure SealantsDISGONCT04682730

An Implementation Strategy for the Adoption of an Evidence-Based Guideline for Pit-and-Fissure Sealants

A study testing Deliberative Loop in people with Pit-and-Fissure Sealants, run by University of Pittsburgh at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial 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. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Pit-and-Fissure Sealants
What is being tested?
Deliberative Loop
Could I receive a placebo?
No, everyone receives an active treatment
How many people
896 participants
Where
1 siteUnited States
Study dates
1 Jan 2021to 26 Jan 2022
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Employed by Kaiser Permanente Northwest Dental or Permanente Dental Associates
  • Work in a Kaiser Permanente Northwest dental clinic

Who cannot join

  • none

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Kaiser Permanente Center for Health Research

    Portland, Oregon, 97227

Other trials in United States

About this study

Official title: An Implementation Strategy for the Adoption of an Evidence-Based Guideline for Pit-and-Fissure Sealants: Using a Framework From Organizational Development

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.

Read the 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.

Being tested
Deliberative Loop
Keywords
evidence-based clinical practice guideline, dental sealants, Deliberative Democracy, Deliberative Loop

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Deliberative LoopBehavioural

    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.

Study groups in NCT04682730
Study groupRoleWhat they receive
Deliberative LoopExperimental28-page Context-Setting Document; 2-page addendum to Context-Setting Document; 90 minute Deliberative session; 8-page post-session survey
Receives: Behavioral: Deliberative Loop

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 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

    Measured: from one month before the first step to two months after the final step, 1 year.

Secondary outcomes (9)
  1. 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.

    Measured: from planning the survey to gather background information to two months after the final step; an average of 1 year

  2. Cost Per Clinic

    Program costs: Cost per clinic

    Measured: from planning the survey to gather background information to two months after the final step; an average of 1 year

  3. 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.

    Measured: from planning the survey to gather background information to two months after the final step; an average of 1 year

  4. Annualized Costs for Guideline Implementation Interventions

    Program costs: Annualized costs for guideline implementation interventions

    Measured: from planning the survey to gather background information to two months after the final step; an average of 1 year

  5. 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.

    Measured: from planning the survey to gather background information to two months after the final step; an average of 1 year

  6. NCCL Treatment Costs- Total Program Costs Per Sealant Per Clinic

    Program costs: NCCL treatment costs- Total program costs per sealant per clinic

    Measured: from planning the survey to gather background information to two months after the final step; an average of 1 year

  7. 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.

    Measured: from planning the survey to gather background information to two months after the final step; an average of 1 year

  8. 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.

    Measured: 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)

  9. 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.

    Measured: from one month before the first step to two months after the final step, 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Dec 2020
  2. Study start1 Jan 2021
  3. Primary completion31 Dec 2021
  4. Study completion26 Jan 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Not applicable
Intervention model
Sequential
Model description
Stepped wedge. In addition to the vanguard clinic, there will be five steps, each with three clinics.
Masking
None (open label)
Enrolment
896 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04682730
Sponsor's protocol ID
STUDY20020201
Other IDs
U01DE027452, 17-077-E
Acronym
DISGO
Status last verified
Jul 2023
First submitted
16 Dec 2020
Last updated
12 Jul 2023
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The IPD sharing plan includes sharing with other researchers all collected, deidentified IPD.

Publications

  • Dawson T, Kaplan CD, Polk DE. Public health and private healthcare: a directed content analysis of citizenship behavior in transcripts from online deliberative engagement among oral healthcare providers considering implementation of an evidence-based clinical practice guideline. BMC Oral Health. 2026 Jun 11. doi: 10.1186/s12903-026-08390-8. Online ahead of print.

    PubMed 42277765
  • Polk DE, Shah NH, Dawson T, Gruss I, Pihlstrom DJ, Kaplan CD, Guerrero EG, Fellows JL. Results from a cluster-randomized, stepped-wedge trial testing a deliberative engagement intervention to increase guideline adherence among U.S. oral health providers. Sci Rep. 2025 May 25;15(1):18180. doi: 10.1038/s41598-025-03236-9.

    PubMed 40415002
  • Gruss I, Dawson T, Kaplan CD, Pihlstrom DJ, Fellows JL, Polk DE. Utilizing deliberative engagement for identifying implementation strategy priorities: lessons learned from an online deliberative forum with dental professionals. Implement Sci Commun. 2023 Sep 21;4(1):119. doi: 10.1186/s43058-023-00496-2.

    PubMed 37735706
  • Gruss I, Dawson T, Kaplan CD, Pihlstrom DJ, Reich S, Fellows JL, Polk DE. Sharing voice during deliberative engagement to improve guideline adherence in dental clinics: findings from a qualitative evaluation of an online deliberative forum discussion. BMJ Open. 2023 Jul 5;13(7):e072727. doi: 10.1136/bmjopen-2023-072727.

    PubMed 37407045
  • Polk D, Shah NH, Dawson T, Gruss I, Pihlstrom DJ, Kaplan CD, Guerrero EG, Fellows JL. Testing a Deliberative Democracy Engagement Intervention to Increase Guideline-Concordance Among Oral Health Providers: Results from the DISGO Cluster-Randomized, Stepped-Wedge Trial. Res Sq [Preprint]. 2023 May 4:rs.3.rs-2757518. doi: 10.21203/rs.3.rs-2757518/v1.

    PubMed 37205489
  • Polk DE, Guerrero EG, Gruss I, Shah NH, Yosuf NM, Dawson T, Kaplan CD, Pihlstrom DJ, Fellows JL. Study protocol: A stepped-wedge, cluster-randomized trial of the effectiveness of a deliberative loop in identifying implementation strategies for the adoption of a dental sealant guideline in dental clinics. Implement Sci Commun. 2021 Aug 28;2(1):96. doi: 10.1186/s43058-021-00199-6.

    PubMed 34454637

Questions about this trial

What is this clinical trial studying?

A study testing Deliberative Loop in people with Pit-and-Fissure Sealants, run by University of Pittsburgh at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 15 Mar 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Providers' Rates of Placing or Treatment Planning Sealants for Occlusal NCCLs (time frame: from one month before the first step to two months after the final step, 1 year.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04682730, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jul 2023.

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