Practice change toward better adherence to evidence-based treatment of early dental decay in the National Dental PBRN

Abstract

BackgroundSignificant national investments have aided the development of practice-based research networks (PBRNs) in both medicine and dentistry. Little evidence has examined the translational impact of these efforts and whether PBRN involvement corresponds to better adoption of best available evidence. This study addresses that gap in knowledge and examines changes in early dental decay among PBRN participants and non-participants with access to the same evidence-based guideline. This study examines the following questions regarding PBRN participation: are practice patterns of providers with PBRN engagement in greater concordance with current evidence? Does provider participation in a PBRNs increase concordance with current evidence? Do providers who participate in PBRN activities disseminate knowledge to their colleagues?MethodsLogistic regression models adjusting for clustering at the clinic and provider levels compared restoration (dental fillings) rates from 2005–2011 among 35 providers in a large staff model practice. All new codes for early-stage caries (dental decay) and co-occurring caries were identified. Treatment was determined by codes occurring up to 6 months following the date of diagnosis. Provider PBRN engagement was determined by study involvement and meeting attendance.ResultsIn 2005, restoration rates were high (79.5%), decreased to 47.6% by 2011 (p < .01), and differed by level of PBRN engagement. In 2005, engaged providers were less likely to use restorations compared to the unengaged (73.1% versus 88.2%; p < .01). Providers with high PBRN involvement decreased use of restorations by 15.4% from 2005 to 2008 (2005: 73%, 2008: 63%; p < .01). Providers with no PBRN involvement decreased use by only 7.5% (2005: 88%, 2008: 82%; p = .041). During the latter half of 2008 following the May PBRN meeting, attendees reduced restorations by 7.5%, compared to a 2.4% among non-attendees (OR = .64, p < .01).ConclusionsBased on actual clinical data, PBRN engagement was associated with practice change consistent with current evidence on treatment of early dental decay. The impact of PBRN engagement was most significant for the most-engaged providers and consistent with a spillover effect onto same-clinic providers who were not PBRN-engaged. PBRNs can generate relevant evidence and expedite translation into practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0177-x) contains supplementary material, which is available to authorized users.

Concordance between responses to questionnaire scenarios and actual treatment to repair or replace dental restorations in the National Dental PBRN

“…30 Indeed, clinician participation in dental PBRNs has helped the implementation of clinical scientific evidence into everyday patient care. 313233 …”

Leveraging Electronic Dental Record Data for Clinical Research in the National Dental PBRN Practices

“…4 In the last decade, electronic dental record (EDR) data have been increasingly used for clinical research and quality improvement purposes in academic settings and larger health care systems. [5][6][7][8][9][10] Studies in Europe and Canada have also utilized longitudinal data from solo and group practices to assess treatment outcomes, such as longevity of composite versus amalgam restorations. [11][12][13][14] These authors highlighted the need for more studies from practice-based contexts to study more-diverse patient cohorts and restorative procedures not performed in well-controlled randomized controlled trials.…”

“…A patients' DOB was assessed as incorrect if the patients' calculated age was less than 0 years or greater than 100 years. A tooth number was considered incorrect if it was outside the range 1 to 32, or tooth numbers were represented as tooth ranges (e.g., [2][3][4][5][6][7][8]. Observations that represented tooth surfaces other than facial (F), buccal (B), mesial (M), distal (D), lingual (L), and occlusal (O) were considered incorrect.…”

How to Bridge Research Results to Everyday Clinical Care?

“…The improvement was toward using more prevention to treat dental caries and delaying the surgical treatment process in certain instances, according to the latest evidence-based research results. 48,49 We learned that a highly interactive meeting with fellow practitioner-investigators could be an effective mean to apply scientific findings into clinical practice, as clinicians reported that they would change how they treat patients as a result of being engaged in the scientific process. This “change in intention” is consistent with the health change theory, which suggests that this step is a prelude to the subsequent next step, which is the actual implementation of change in the practice.…”