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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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Clinicians attending network dissemination of meeting and their impact on colleagues. (a) Change in restoration rates by 2008 National DPBRN meeting attendance*. (b) Change in 2008 restoration rates among non-attendees**.
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Fig2: Clinicians attending network dissemination of meeting and their impact on colleagues. (a) Change in restoration rates by 2008 National DPBRN meeting attendance*. (b) Change in 2008 restoration rates among non-attendees**.

Mentions: A sharper illustration of the change in care patterns that occurred following the May 2008 PBRN meeting of practitioners is provided in the upper portion of FigureĀ 2, which contrasts restoration rates prior to the meeting with those after the meeting. Among the 35 providers included in the study, 14 attended the 2008 conference (all of those in the 2 most-engaged groups and 10 of the 11 providers in the Surveys and Studies group). Prior to the meeting, attendees restored 82.2% of tooth surfaces with diagnostic codes. After the meeting, attendee restoration rates dropped to 73.9%. In contrast, there was no significant change among non-attendees (pre-meeting: 82.6%; post-meeting: 81.8%).Figure 2


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)

Clinicians attending network dissemination of meeting and their impact on colleagues. (a) Change in restoration rates by 2008 National DPBRN meeting attendance*. (b) Change in 2008 restoration rates among non-attendees**.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Clinicians attending network dissemination of meeting and their impact on colleagues. (a) Change in restoration rates by 2008 National DPBRN meeting attendance*. (b) Change in 2008 restoration rates among non-attendees**.
Mentions: A sharper illustration of the change in care patterns that occurred following the May 2008 PBRN meeting of practitioners is provided in the upper portion of FigureĀ 2, which contrasts restoration rates prior to the meeting with those after the meeting. Among the 35 providers included in the study, 14 attended the 2008 conference (all of those in the 2 most-engaged groups and 10 of the 11 providers in the Surveys and Studies group). Prior to the meeting, attendees restored 82.2% of tooth surfaces with diagnostic codes. After the meeting, attendee restoration rates dropped to 73.9%. In contrast, there was no significant change among non-attendees (pre-meeting: 82.6%; post-meeting: 81.8%).Figure 2

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