Gregg H. Gilbert, DDS, MBA, FAAHD, FACD Presentation to the National Rural Health Association National…

Gregg H. Gilbert, DDS, MBA, FAAHD, FACD

Presentation to the National Rural Health AssociationNational Rural Task Force

June 8, 2010

Network Chair of “The Dental PBRN”Professor and Chair, Dept. of General Dental SciencesUniversity of Alabama at Birmingham School of Dentistry

Support: U.S. National Institutes of Health grants U01-DE-16746 and U01-DE-16747

The Dental Practice-Based Research Network: a ‘win-win’ for all involved

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.

Designed to gather “real-world” evidence for the prevention and treatment of oral diseases.

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

Mission: To improve oral health by conducting dental practice-based research and by serving dental professionals

through education and collegiality.

What are we supposed to be accomplishing?

The DPBRN regions

The main decision-making body of the network

Majority voting authority lies with the six practitioner-investigator representatives

The DPBRN Executive Committee

The DPBRN Executive Committee

AL/MSDr. Gerald AndersonSelma, AL

member-at-large forcombined AL/MS, FL/GA regionDr. Martha WallaceBirmingham, AL

FL/GADr. Paul BenjaminMiami, FL

HP/MNDr. Pat FoyMinneapolis, MN

PDADr. Dan PihlstromPortland, OR

SKDr. Lotta PerssonTyringe, Sweden

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

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Practitioner-investigators are engaged at every step of the process

“My staff and I were delighted to be a part of the DPBRN study on Blood Glucose levels. .. The testing of blood glucose levels in the dental office would definitely be useful in the dental setting. The patients were receptive to the idea of being able to know if their blood glucose level was within normal range… Our patients were impressed to know that we place great emphasis on their total health by participating in the study. The staff enjoyed being part of the study …”

Adolphus Jackson, DMD, Private practice in Birmingham, AL

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Practitioner-investigators are engaged at every step of the process

Dr. James Sanderson Dr. Burton McGee Hoover, AL Florence, AL

Crucial roles in developing the “Prevalence of questionable occlusal caries” study.

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Practitioner-investigators are engaged at every step of the process

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Practitioner-investigators are engaged at every step of the process

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Practitioner-investigators are engaged at every step of the process

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Data collection completed (12 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 first 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”

Update on DPBRN studies as of May 2010

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In data collection phase (4 studies)- “Development of a patient-based provider intervention for

early caries management” (should finish this Summer)- “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”

Update on DPBRN studies as of May 2010

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Approved and/or recruitment is underway- “Hygienists’ internet tobacco cessation randomized clinical trial” (recruitment underway)- “Peri-operative pain and root canal therapy” (recruitment

underway)- “Persistent pain and root canal therapy”

Update on DPBRN studies as of May 2010

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“Research that works” = “win-win” for all involved

- remuneration provided for time it takes to do the study; does not rely on ‘volunteer spirit’

- improves quality of care; a tool to answer questions and address needs of the center and its patients

- promotes recruitment and retention of dentists by being known as a “research center”

- emerging HRSA emphasis on documenting quality of care and accountability

- something to stand apart from others when competing for HRSA grant applications

- opportunity to improve health and health care in the medical-dental interface- university affiliation - heightens perceived credibility within market

Benefits of particular interest to community health centers

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

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 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

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Keeping DPBRN transparenttransparenthttp://www.DPBRN.org

Thank you!

slides from this point forward will not be presented

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?

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4 countries, 5 regions, 8 IRBs more than 953 practitioners have completed at least

one DPBRN study substantial diversity of patients, practitioners, practice

types, geographic regions, treatment approaches (with publications that demonstrate this)

data on more than 24,000 different patients; 11 studies completed so far; most studies are large; broad range of study types (including 2 RCTs); studies practical in nature that are readily translatable to daily practice

36 publications accepted so far, increasing regularly substantial involvement and commitment by p-i’s at

every step of the process

DPBRN Year 05 report - a lot of activity!

We have made a point of …

listening to a wide range of full-time practitioners

listening closely

listening often

What are we supposed to be accomplishing?

Dr. Jocelyn McClelland, AL: “The DPBRN meeting had a large impact on my practice. I have attended many continuing education programs in my 20 years of practicing dentistry, but this was the first one that I actually implemented knowledge gained on the weekend into my practice on Monday morning! It really made me appreciate being a part of such an important project.”

Some comments from attendees at the Atlanta meeting

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Practitioner-investigators are engaged at every step of the process

- can become part of the solution; cannot “drill our way out of this”

Benefits of particular interest to community health centers