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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:

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Dental Practice-Based Research

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  1. 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

  2. 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

  3. 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?

  4. 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.)

  5. A group of practitioners engaged in practice-base research constitutes a Practice-based Research Network (PBRN). What is a Practice-based Research Network (PBRN)?

  6. Institutionally-based Research Publications Policy Development Clinical Guidelines

  7. Analysis of Data Generated by Patient Care Policy Development Clinical Guidelines Publications

  8. Practice-based Research Publications Policy Development Clinical Guidelines

  9. 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

  10. 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.)

  11. 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.)

  12. 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.)

  13. NIDCR Dental Practice-Based Research Networks Cooperative Agreements Awarded 5/01/2005 $75 million over 7 years Awardees • NYU PEARL Network • Universities of Alabama / Florida DPBRN Network • Permanente Dental Associates • Health Partners • Georgia • Mississippi • Scandinavia • Universities of Washington / Oregon NW PRECEDENT Network • TransPBRN entity comprising all three networks CONDOR Network

  14. Dental Practice-based Research Networks Current Status: Year 5 • 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

  15. Snapshot of Dental PBRNs’ Current Membership, by State

  16. Examples of the types of clinical studies being conducted by the NIDCR Funded PBRNS: • 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

  17. Examples of the types of clinical studies being conducted by the NIDCR Funded PBRNS (cont.) • 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

  18. 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)

  19. VA PRACTICE-BASED RESEARCH NETWORK

  20. 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)

  21. VADER Participants • 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. Integrated Approach to Research, Education, and Quality Care Oral Health Providers VA Leadership Informs Improved Veteran Oral Health VADER PBRN Education Group Informs Informs Quality Group

  28. 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)

  29. 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

  30. 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

  31. 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

  32. VA Dental Record Manager Module: CPRS

  33. 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

  34. 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

  35. VADER Study One: Assessment of Caries Diagnosis and Treatment A Quality Survey

  36. VADER Study One: Assessment of Caries Diagnosis and Treatment A Quality Survey

  37. Retrospective Case-Control study of ONJ in Veterans (VA funded) Osteonecrosis of the Jaw: VADER/UAB/ IOWA City VA/ VA Pharmacy

  38. Endodontic Outcomes Study VADER PBRN Research Portfolio Studies in Development

  39. Xerostomia Survey VADER PBRN Research Portfolio Studies in Development

  40. Prosthetic replacement of teeth VADER PBRN Research Portfolio Studies in Development

  41. VA Cranial Implant Registry: A Joint VA / DOD project

  42. ADA Professional Product Review (PPR) – VADER

  43. 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

  44. ADA Professional Product Review (PPR) – VADER • Electric Dental Handpieces (Drills) • Shade Guides

  45. 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

  46. Integrated Approach to Research, Education, and Quality Care Improved Patient Oral Health

  47. VA Office of Dentistry (OOD) Integrated approach to research, education, and quality measures Donald J. DeNucci, D.D.S., M.S.Research Consultant/VA Office of Dentistry Program Officer/NIH/Practice-based Research Telephone: 301-451-5096Preferred E-mail:  denuccid@nidcr.nih.govVA Outlook: denucci.donald@va.gov

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