Download - Dental Practice-Based Research
Dental Practice-Based Research
Donald J. DeNucci D.D.S., M.S.Research Consultant/VA Office of Dentistry
Program Officer/NIH/Practice-based Research Networks
Dental Practice-based Research:
Conducted in the “real world” of clinical dentistry and designed to improve oral health and to
support the adoption of evidence-based clinical practice
Dental Practice-Based Research
Practice-based research is research conducted in clinical practices by practitioners/clinicians
Designed to answer questions practitioners face in the routine care of their patients.
What is Practice-based Research?
Practice-based research holds great potential for answering clinical questions and expediting the translation of research findings into clinical practice.
What is Practice-based Research? (cont.)
A group of practitioners engaged in practice-base research constitutes a Practice-based Research Network (PBRN).
What is a Practice-based Research Network (PBRN)?
Institutionally-based Research
PublicationsPolicy DevelopmentClinical Guidelines
Analysis of Data Generated by Patient Care
Policy DevelopmentClinical Guidelines
Publications
Practice-based Research
PublicationsPolicy DevelopmentClinical Guidelines
Practice-based research began when small groups of European medical practitioners began sharing information pertinent to patient care and clinical outcomes
These early precursors to today’s practice-based research networks can be traced back to the European sentinel networks of the 1970’s.
History of Practice-based Research
This sentinel model soon took hold in the United States as the Ambulatory Sentinel Practice Network (ASPN)
Followed closely by the establishment of the Pediatric Research in Office Settings (PROS) in 1984
History of Practice-based Research (cont.)
Currently there are over 120 primary care PBRNs known to be active in the U.S. which include about 20,000 practices of pediatrics, family medicine, and general internal medicine located in all 50 States
These practices provide care for more than 20 million Americans (Agency for Healthcare Research and Quality 2008).
History of Practice-based Research (cont.)
The dental profession has only recently recognized the value of practice-based research with the establishment of the Community Research for Oral Health Wellness Network (CROWN) in 2001
NIDCR/NIH funded the establishment of three large dental practice-based research networks in 2005.
History of Practice-based Research (cont.)
NIDCR Dental Practice-Based Research
NetworksCooperative Agreements
Awarded 5/01/2005
$75 million over 7 years
Awardees NYU PEARL Network Universities of Alabama / Florida DPBRN Network
Permanente Dental AssociatesHealth PartnersGeorgia Mississippi Scandinavia
Universities of Washington / Oregon NW PRECEDENT Network TransPBRN entity comprising all three networks CONDOR Network
Engages over 700 practitioners in several diverse geographic regions
Conducting or completed over 30 studies including a CONDOR case-control study of ONJ
Produced several manuscripts including the first book chapter on practice-based research*
Multiple abstracts, symposia, and invited presentations
*DeNucci DJ and CONDOR Dental Practice-Based Research Networks.“Dental Practice-based Research”. Clinical Research in Oral Health.Eds. Gainnobile, Burt, and Genco. Wiley Blackwell. 2010. 265-30
Snapshot of Dental PBRNs’ Current Membership, by
State
Effectiveness of various strategies for the diagnosis of dental caries, periodontal disease, and oral cancer
Effectiveness of strategies to prevent progression of caries and periodontal disease
Natural history of untreated oral conditions, such as partially erupted third molars or cracked teeth
Effectiveness of interventions for treating and managing periodontal disease and caries
Examples of the types of clinical studies being conducted by the NIDCR Funded PBRNS:
Assessing variations associated with the delivery of dental health care
Assessing patient compliance with treatment recommendations
Effectiveness of various strategies for managing acute and chronic orofacial pain
Assessing the outcomes of various treatments such as endodontic therapy, dental implants, and other prosthetics and restorative modalities
Examples of the types of clinical studies being conducted by the NIDCR Funded PBRNS (cont.)
NIDCR PBRN Research Activities Year Five
DPBRN: Studies are focusing on treatment strategies for treating early carious lesions, patient satisfaction with dental restorations, reasons for replacing dental restoration, diabetes screening, smoking cessation
PEARL: Studies are focusing on treatment strategies for advanced dental caries, survival of endo treated teeth , sensitive teeth, analgesic prescribing practices, periodontal disease diagnosis, oral cancer screening
PRECEDENT: Studies focusing on caries risk assessment, dental pulp capping, wisdom tooth removal, orthodontic anchorage devices, white spot lesions (early caries)
VA PRACTICE-BASED RESEARCH NETWORK
Deployed in September 2007
A virtual network open to all 750+ VA Dental Professionals
Governed by an executive committee of “volunteers” composed of VA practitioners, researchers, IT experts, educators, residents, and fellows
VA Dental Practice-Based Research Network (VADER)
204 dental clinics VA wide 127 facilities (hospitals) 77 outpatient clinics
Oral Health Research Officers (OHRO) 44 Officers: Certified VA Researchers VA wide
37 Dentists 7 Dental Hygienists
VADER Participants
Our Mission... The mission of the Veterans Healthcare System is to serve the needs of America's veterans by providing primary care, specialized care, and related medical and social support services.
To accomplish this mission, VHA needs to be a comprehensive, integrated healthcare system that provides excellence in health care value, excellence in service as defined by its customers, and excellence in education and research,………
VA Mission Statement
VA OOD Quality Group
VA OOD Education Initiative
VA Dental Practice-based Research Network (PBRN)
VA Office of Dentistry (OOD) Integrated approach to research, education, and quality measures
Mission is to improve the oral health of veterans by promoting clinical practice based on the best evidence available
Develops Quality Indicators and Scorecards
Develops Information Papers
Develops Clinical Guidelines
VA OOD Quality Group
Mission is to improve the oral health of veterans by enhancing the translation and implementation of evidence into clinical practice
Provides monthly VA wide webinars on topics of interest to the VA Dental Team
Maintains a VA website with educational materials, archived webinars, and links to educational resources for Program Directors and others
VA OOD Education Group
Mission is to conduct research and provide answers to the questions facing VA Dentists in their daily practices
Strengthen the knowledge base for making clinical decisions.
Provide data to the VA Quality Group to assist them in addressing issues of greatest importance to the oral health of veterans
Provide information to the Educational Group to guide the development of education and training for the VA Dental Team
VA Dental Practice-based Research Network
Improved Veteran Oral
Health
Quality Group
VADER PBRN Education Group
Informs
Oral Health Providers
VA Leadership
Informs
Info
rms
Integrated Approach to Research,
Education, and Quality Care
Primary objectives: Conduct clinical studies to improve the health of
Veterans Emphasize effectiveness of oral health treatment and
disease prevention Facilitate clear and clinically meaningful outcomes
Secondary objectives: Surveillance: Provide data on disease and treatment
trends Obtain estimates of the prevalence of less common
conditions
VA Dental Practice-Based Research Network (VADER)
Research Ideas: Stimulated by the clinical challenges faced by VA
practitioners
Generated by practicing dentists and dental hygienists (i.e. practitioner - investigators)
Accepted from sources outside the VA PBRN (academia, individuals, etc…)
Dental Practice-Based Research Network in the VA
A virtual network with no defined budget and staffed by volunteer VA dental professionals!
The first VA practice-based research network!
Unique Aspects of the VADER PBRN
STRENGTHS
Electronic Health Records
Uniform Practice Environment
Relatively Stable Research Population
Access to the superb VA Research Culture
Potential Access to the VA Central IRB
Establishing A Research Network in the VA
VA Dental Record Manager Module: CPRS
CHALLENGES
Integration of research into a patient care environment
Providing incentives to participate in research
Managing fluctuations in fiscal and other support resources
Establishing A Research Network in the VA
VADER Study One: Assessment of Caries Diagnosis and Caries Treatment
Risk factors for ONJ in Veterans
Survival Root Canal Treated Teeth
Xerostomia Treatment Survey
VALPLAST Prosthodontic Survey
Oral Cancer Screening
VA/DOD Registry of Cranial Implants
ADA Professional Products Review
VADER PBRN Research Portfolio Projects in development or
deployed
A Quality Survey
VADER Study One: Assessment of Caries Diagnosis and
Treatment
A Quality Survey
VADER Study One: Assessment of Caries Diagnosis and
Treatment
Retrospective Case-Control study of ONJ in Veterans (VA funded)
Osteonecrosis of the Jaw: VADER/UAB/ IOWA City VA/
VA Pharmacy
Endodontic Outcomes Study
VADER PBRN Research Portfolio Studies in
Development
Xerostomia Survey
VADER PBRN Research Portfolio Studies in
Development
Prosthetic replacement of teeth
VADER PBRN Research Portfolio Studies in
Development
VA Cranial Implant Registry:
A Joint VA / DOD project
ADA Professional Product Review (PPR) – VADER
Evaluation of dental products and equipment by VA Dental Professionals
Provided by the American Dental Association; hence no direct contact with industry
Evaluated in the real-world environment of VA clinical practice
Potential to inform VA acquisition decisions and the oral health community in general
ADA Professional Product Review (PPR) – VADER
ADA Professional Product Review (PPR) – VADER
Electric Dental Handpieces (Drills) Shade Guides
Web/computer based smoking cessation study
Implant outcomes study
Implact of fluoride prescriptions and treatments on dental caries in Veterans
VADER PBRN Research Portfolio Studies under
Consideration
Integrated Approach to Research, Education, and
Quality Care
Quality Group
Education
ResearchPBRN
Improved Patient Oral
Health
Donald J. DeNucci, D.D.S., M.S.Research Consultant/VA Office of DentistryProgram Officer/NIH/Practice-based Research Telephone: 301-451-5096Preferred E-mail: [email protected] Outlook: [email protected]
VA Office of Dentistry (OOD) Integrated approach to research, education, and quality measures
