A group of dental practices that has affiliated to investigate research questions and to engage in sharing experiences and expertise.

What is a dental practice-based research network (PBRN)?

A group of dental practices that has affiliated to investigate research questions and to engage in sharing experiences and expertise.

The network conducts research that is done by and about the “real world” of daily clinical practice, where the overwhelming majority of the population receives its dental care.

What is a dental practice-based research network (PBRN)?

Laboratory Clinical trials Practice-based Community- research in academic research based

settings research

when treatment is… ____ not ready for not ready for not ready for not ready for humans1 patients practices communities

1 most of the “not ready” terms adapted with revision from James W. Mold, MD, MPH

How is PBRN research different from other types of research?

Rigorous but not relevant

A knowledge explosion

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passive generation of knowledge usually either does not work or is very slow

substantial difference between the health care that we are eligible for and the care that we actually receive

ReferencesQuality improvement: science and action. Circulation 2009; 119: 1962-1974.How can primary care cross the quality chasm? Annals Fam Med 2009; 7(2): 164-169.The neglected purpose of comparative-effectiveness research. N Engl J Med 2009;

360(19): 1929-1931.Life cycle of translational research for medical interventions. Science 2008; 321:1298-

1299.Clinical research to clinical practice – lost in translation? N Engl J Med 2003; 349(9): 868-

874.

Can we rely on generation of new knowledge to improve public health?

Source: Practice-based research …J Am Med Assoc 2007; 297: 403-406.

Dissecting the “translational” process

• “If we want more evidence-based practice, we need more practice-based evidence.”

– Lawrence W. Green, DrPH

• seeing knowledge translation as a one-way street and blaming the health care providers is not the solution

• better delivery of established therapies would save more lives than the next innovation in therapy

ReferencesQuality improvement: science and action. Circulation 2009; 119: 1962-1974.How can primary care cross the quality chasm? Annals Fam Med 2009; 7(2): 164-169.

Moving things forward…

We need to engage the practitioners and their patients in the whole research process

NIDCR funded three dental PBRNs in 2005

The DPBRN regions

Would we really be able to recruit a large number of dentist practitioners?

Would we really be able to establish the necessary regulatory and contractual relationships? Would dentists in busy clinical practice really be effective at doing studies in their practices? Would practitioner-investigators really contribute ideas

for research projects? Would they really participate at every step of the research process?

Many skeptics asked …

Practical science done about, in, and for the benefit of “real world" clinical practice.

A network about, with, and for practitioner-investigators and their patients

Benefits of participating as communicated by practitioner-investigators

• Provides a focus for clinical excellence by devoting increased short-term attention to one particular area of clinical practice at a time

• Can improve the logistics of daily clinical operations, serve as a team builder for practice staff, and

engage the entire staff in the excitement of discovery and quality improvement

• Projects can improve the quality of dental care by contributing to the scientific basis for the dental procedures that are their focus

Benefits of participating as communicated by practitioner-investigators

• Provides venues for collegial interactions and exchange of ideas with fellow practitioner-investigators; become

part of a community of learning and camaraderie

• Receive CE credit for attendance at DPBRN annual meetings and participating in training and certification activities for specific DPBRN studies

• Receive certificates suitable for framing and display in the office

Benefits of participating as communicated by practitioner-investigators

• Receive financial remuneration for the time spent doing research

• Allows practitioner-investigators to see what is effective in their practices in comparison to other practices – using results that are presented anonymously

• Practitioner-investigators decide what studies are done and what treatment is done - not third parties

• Potential to present at local, state, national, and international dental meetings and research conferences

Benefits as communicated by DPBRN practitioner-investigators themselves

• Distinguishes the practice from other practices, acting as a practice promoter or practice builder

• Increases the practice's visibility and stature among dental patients

• Enhances communication with patients by showing that the practitioner-investigator cares about the scientific basis of clinical practice

• Expands the vision for patient care by including a formalized research and quality improvement component to it

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Data collection completed (14 studies)- “Dental tobacco control randomized clinical trial”- “Practice-based root canal treatment effectiveness”- “Assessment of caries diagnosis and caries treatment” - “Case-control study of osteonecrosis of the jaws” - “Retrospective cohort study of osteonecrosis of the jaws”- “Reasons for placing the 1st restoration on permanent tooth surfaces”- “Reasons for replacement or repair of dental restorations”- “Patient satisfaction with dental restorations”- “Assessing impact of participation in practice-based research on

clinical practice and patient care”- “Prevalence of questionable occlusal caries lesions”- “Blood glucose testing in dental practice” - “CONDOR TMJD study”- “Development of a patient-based provider intervention for early caries

management” - “Peri-operative pain and root canal therapy”

Update on DPBRN studies as of February 2011

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In data collection phase (5 studies)- “Longitudinal study of dental restorations placed on previously un-restored surfaces”- “Longitudinal study of questionable occlusal caries lesions”- “Longitudinal study of repaired or replaced dental restorations”- “Hygienists’ internet tobacco cessation randomized clinical trial” - “Persistent pain and root canal therapy”

Update on DPBRN studies as of February 2011

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Number of units in 16 DPBRN studies to dateStudy title # of practitioner-

investigatorsNumber of patients, procedures or other

entities

Dental tobacco control randomized clinical trial 190 11,898 patients

Practice-based root canal treatment effectiveness 13 84 patients, 174 treated teeth

Assessment of caries diagnosis and caries treatment 565 --

Reasons for placing the first restoration on permanent tooth surfaces 227 5,810 patients; 9,902 dental restorations

Reasons for replacement or repair of dental restorations 200 6,244 patients; 9,800 restorations

CONDOR case-control study of osteonecrosis of the jaws 37 296 patients

Retrospective cohort study of osteonecrosis of the jaws -- 572,606 patients

Longitudinal study of dental restorations placed on previously un-restored surfaces

207 5,332 patients; 9,270 dental restorations

Longitudinal study of repaired or replaced dental restorations 200 5,800 patients; 9,800 restorations

Development of a patient-based provider intervention for early caries management

10 330 patients

Patient satisfaction with dental restorations 200 4,640 patients

Prevalence of questionable occlusal caries lesions 96 2,552 caries lesions

Longitudinal study of questionable occlusal caries lesions 96 2,552 caries lesions

Blood glucose testing in dental practice 25 375 patients

Assessing the impact of participation in practice-based research on clinical practice and patient care

686 --

Primary care management of TMJD disorders 400+ --

Totals 3,152 84,415 (excludes 1 study)