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Heiko Spallek, DMD, PhD, MSBA(CIS) Principal Investigator, 1R21DE021494, NIDCR

Implementing Research Findings and Evidence-Based Interventions into Real-World Dental Practice Settings. Heiko Spallek, DMD, PhD, MSBA(CIS) Principal Investigator, 1R21DE021494, NIDCR. Collaborators Tanja Bekhuis,PhD, MS, MLIS Marnie Oakley, DMD Jean O’Donnell, DMD Deborah E. Polk, PhD

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Heiko Spallek, DMD, PhD, MSBA(CIS) Principal Investigator, 1R21DE021494, NIDCR

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  1. Implementing Research Findings and Evidence-Based Interventions into Real-World Dental Practice Settings Heiko Spallek, DMD, PhD, MSBA(CIS) Principal Investigator, 1R21DE021494, NIDCR Center for Dental Informatics University of Pittsburgh

  2. Collaborators Tanja Bekhuis,PhD, MS, MLIS Marnie Oakley, DMD Jean O’Donnell, DMD Deborah E. Polk, PhD Titus Schleyer, DMD, PhD Mei Song, PhD Thankam Thyvalikakath, MDS, MS Benita Valappil, MPH Adriana Modesto Vieira, DDS, MS, PhD Robert Weyant, MS, DMD, DrPH many more… The project is supported by Award Number 1R21DE021494 from the National Institute of Dental and Craniofacial Research

  3. The Problem gap between research discovery and health care delivery K. Davis, C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss, and K. K. Shea, Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007

  4. The Problem fallacy: efficacious intervention transmitted to the field Little knowledge about how to support - dissemination - implementation “We are now witnessing a global societal struggle to assure universal delivery of our know-how. We in medicine, however, have been slow to grasp why this is such a struggle, or how the volume of discovery has changed our work and responsibilities.” AtulGawande, 2011 commencement address at Harvard Medical School

  5. Public Perception http://www.rd.com/health/is-your-doctor-out-of-date/

  6. Time in Practice and Quality of Care Choudhry, et al. Ann Intern Med 142:260-273, 2005 Conclusions: “…physicians who have been in practice for more years and older physicians possess less factual knowledge, are less likely to adhere to appropriate standards of care, and may also have poorer patient outcomes.”

  7. Larger Picture The Road Ahead: A Report by the National Advisory Mental Health Council's Services Research and Clinical Epidemiology Workgroup http://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/road-ahead.pdf The NIMH Strategic Plan http://www.nimh.nih.gov/about/strategic-planning-reports/index.shtml Designing for Dissemination Conference Summary Report http://cancercontrol.cancer.gov/d4d/info.html#conferences Diffusion and Dissemination of Evidence-based Cancer Control Interventions http://www.ahcpr.gov/clinic/epcsums/canconsum.htm National Institute on Drug Abuse Blue Ribbon Task Force Report on Services Research http://www.drugabuse.gov/about/organization/nacda/HSRReport.pdf

  8. Dissemination Research = how information about health promotion, treatment, preventive and services interventions is packaged, transmitted, and interpreted among a variety of important stakeholder groups Implementation Research = how to guide efforts to fit health interventions within real-world public health, clinical and community service systems

  9. Submissions/Award FOA uses NIH Exploratory/Developmental Research Grant (R21) Dissemination Research Implementation Research Novel Dissemination Approaches for Evidence-Based Guidelines in Dentistry: Exploiting the Power of Web 2.0 Technologies 1R21DE021750 First Submission: Impact/Priority Score: 34 Resubmission: Not discussed Implementing Research Findings and Evidence-Based Interventions into Real-World Dental Practice Settings R21DE019680 First Submission: Impact/Priority Score: 187 1R21DE021494 “Re” Submission: Impact/Priority Score: 23

  10. Purpose • contribute to the development of next generation dental EHR • overcome perceived and real barriers to the acceptance of EBD

  11. Central Hypothesis We will overcome information barriers by tailoring informatics solutions for dentists by providing the right information • at the right time, • to the right person, • in the right format.

  12. Preliminary Studies 1: unmet needs: access to patient-specific EB information Song M, Spallek H, Polk D, Schleyer T, Wali T. How information systems should support the information needs of general dentists in clinical settings: suggestions from a qualitative study. BMC Medical Informatics and Decision Making. 2010; 10(7)

  13. Preliminary Studies 2: Dentists will use EB tools if they are available. Spallek H, Song M, Polk DE, Bekhuis T, Frantsve-Hawley J, Aravamudhan K. Barriers to implementing evidence-based clinical guidelines: A survey of early adopters The Journal of Evidence-Based Dental Practice (2010)4, 195-206. doi: 10.1016/j.jebdp.2010.05.013

  14. Preliminary Studies 3: Chairside computers are an untapped source of evidence-based treatment information and clinical decision support. Schleyer TK, Thyvalikakath TP, Spallek H, Torres-Urquidy MH, Hernandez P, Yuhaniak J. Clinical computing in general dentistry. J Am Med Inform Assoc 2006;13(3):344-52. PM:16501177

  15. Preliminary Studies 4: Many factors affect the dental examination and treatment planning process. Irwin JY, Torres-Urquidy MH, Schleyer T, Monaco V. A preliminary model of work during initial examination and treatment planning appointments. Br Dent J 2009 Jan 10;206(1):E1. PM:19119286

  16. Preliminary Studies 5: The process of dental diagnosis and treatment planning is rapid and complex. Thyvalikakath TP, Torres-Urquidy MH, Dziabiak MP, Schleyer TKL. Cognitive task analysis of clinicians‘ decision making activities during diagnosis and treatment planning. J Dent Educ 2008;72(2):217.

  17. Specific Aim 1: Identify information barriers to the implementation of research findings & EB interventions

  18. Specific Aim 2: Develop prototypical informatics solutions to overcome information barriers initial brainstorming session: generate list of informatics solutions evaluate & augment the ideas solutions to support integration of treatment guidelines into practice workflow identify 4 most promising designs for prototypical implementation

  19. Specific Aim 3: Implement prototypical informatics solutions to develop a measurement instrument

  20. Status Report • IRB for SA 1 & 2 • cases developed • questionnaire revised • script developed & pilot tested • recruitment started

  21. Future Continue to promote the integration of research findings and EB interventions among practicing dentists. We will use pilot data from this study for a follow-up (R01) study to compare effectiveness of various implementations in a real-world dental practice setting.

  22. Resources • Press Release on CDI Website: http://bit.ly/CDI-EBD • Dental Informatics Online Community: http://www.dentalinformatics.org/projectdirectory/show_project.html?project_id=84 • To learn more about the project http://projectreporter.nih.gov/project_info_description.cfm?aid=8028402&icde=8214153 • ADA Center for Evidence-Based Dentistry http://ebd.ada.org/

  23. Acknowledgement The project described is supported by Award Number R21DE021494 from the National Institute of Dental & Craniofacial Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Dental & Craniofacial Research or National Institutes of Health.

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