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.
Highlights
Significant national investments have aided the development of practice-based research networks (PBRNs) in both medicine and dentistry
Having a clinical guideline does not ensure a change in clinical practice [1], and a review of 59 published evaluations of clinical guidelines concluded that guidelines could improve clinical practice, but the size of the improvements in performance varied considerably [2]
This study examined the impact of participation in a PBRN on practice patterns associated with the treatment of early caries
Summary
Significant national investments have aided the development of practice-based research networks (PBRNs) in both medicine and dentistry. Gilbert and colleagues used questionnaire data from individual practitioners to provide evidence that dental PBRN involvement can be an effective means to move scientific findings into clinical practice [5,6]. Rhyne and colleagues [7] reported change in physician behavior associated with a PBRN study of acanthosis nigricans, as manifested by increased preventive counseling. Yawn and colleagues [8] used semi-structured qualitative telephone interviews in a clinical trial of postpartum depression and concluded that PBRN participation provided advantages to practices that extended beyond the study’s specific purpose, such as adaptation of the study tools to other chronic conditions, increased sense of professional self-worth and community recognition, increased research literacy within the practice, and more effective teamwork with staff. Haines and colleagues [10] reported the first study that combined quantitative and qualitative methods to examine factors that contribute to clinical care networks (not research networks or PBRNs)
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