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

Implementation Science

Gregg H Gilbert²  Andrew M Schmidt¹  Olga V Godlevsky³  Emily U Durand³  Thomas J Flottemesch³  Donald Brad Rindal³ 

[1] Dental Clinic Admin, HealthPartners, 8170 33rd Avenue South, MS 21111R, Bloomington 55425, MN, USA;University of Alabama at Birmingham, 1919 7th Avenue South, Birmingham 35294, AL, USA;HealthPartners Institute for Education and Research, 8170 33rd Avenue South, MS 21111R, Bloomington 55425, MN, USA

关键词: Physician practice patterns;    Performance measurement;    Organizational behavior;    Oral health;    Evidence-based medicine;    Dissemination;    Decision-making;   

Others  :  1137071
DOI  :  10.1186/s13012-014-0177-x

 received in 2014-04-16, accepted in 2014-11-17,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Rindal et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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