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

Rindal DB, Flottemesch TJ, Durand EU, Godlevsky OV, Schmidt AM, Gilbert GH, National Dental PBRN Collaborative Gro - Implement Sci (2014)

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Significant 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?

Methods: Logistic 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.

Results: In 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).

Conclusions: Based 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.

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Related in: MedlinePlus

Restoration rates and network involvement.
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Fig1: Restoration rates and network involvement.

Mentions: We identified 35 HPDG dentists who met the study’s three inclusion criteria: continuously employed at HPDG from January 1, 2005 through December 31, 2011, actively seeing patients for routine exams, and actively performing restorative services for all years during the period of interest. These were distributed across the five previously described levels of PBRN involvement in the following way: 1) No PBRN Involvement (n = 6); 2) Surveys Only (n = 4); 3) Surveys and Studies (n = 11); 4) Surveys, Studies, and Meetings (n = 9); and 5) Surveys, Studies, Meetings, and Presentations (n = 5). Our initial analyses included all five levels of PBRN engagement. In subsequent analyses to better distinguish lower and higher levels of PBRN engagement, we combined levels 1 and 2 and levels 3 and 4 (Figure 1) leaving three final levels of PBRN engagement: Low Involvement (levels 1 and 2); Surveys and Studies (levels 3 and 4); and Studies, Meetings, and Presentations (level 5). These levels distinguish cursory engagement (low), those who—at a minimum—attended at PBRN meeting, and those who actively participated and presented PBRN-related research.Figure 1


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

Rindal DB, Flottemesch TJ, Durand EU, Godlevsky OV, Schmidt AM, Gilbert GH, National Dental PBRN Collaborative Gro - Implement Sci (2014)

Restoration rates and network involvement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4260248&req=5

Fig1: Restoration rates and network involvement.
Mentions: We identified 35 HPDG dentists who met the study’s three inclusion criteria: continuously employed at HPDG from January 1, 2005 through December 31, 2011, actively seeing patients for routine exams, and actively performing restorative services for all years during the period of interest. These were distributed across the five previously described levels of PBRN involvement in the following way: 1) No PBRN Involvement (n = 6); 2) Surveys Only (n = 4); 3) Surveys and Studies (n = 11); 4) Surveys, Studies, and Meetings (n = 9); and 5) Surveys, Studies, Meetings, and Presentations (n = 5). Our initial analyses included all five levels of PBRN engagement. In subsequent analyses to better distinguish lower and higher levels of PBRN engagement, we combined levels 1 and 2 and levels 3 and 4 (Figure 1) leaving three final levels of PBRN engagement: Low Involvement (levels 1 and 2); Surveys and Studies (levels 3 and 4); and Studies, Meetings, and Presentations (level 5). These levels distinguish cursory engagement (low), those who—at a minimum—attended at PBRN meeting, and those who actively participated and presented PBRN-related research.Figure 1

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Significant 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?

Methods: Logistic 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.

Results: In 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).

Conclusions: Based 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.

Show MeSH
Related in: MedlinePlus