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

1. The Dental Practice-Based Research Network: a ‘win-win’ for all involved Gregg H. Gilbert, DDS, MBA, FAAHD, FACD Presentation to the National Rural Health Association National Rural Task Force June 8, 2010 Network Chair of “The Dental PBRN” Professor and Chair, Dept. of General Dental Sciences University of Alabama at Birmingham School of Dentistry Support: U.S. National Institutes of Health grants U01-DE-16746 and U01-DE-16747

2. 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.

3. 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.

4. What are we supposed to be accomplishing? Mission: To improve oral health by conducting dental practice-based research and by serving dental professionals through education and collegiality.

5. The DPBRN regions

6. The DPBRN Executive Committee • The main decision-making body of the network • Majority voting authority lies with the six practitioner- investigator representatives

7. The DPBRN Executive Committee AL/MS Dr. Gerald Anderson Selma, AL HP/MN Dr. Pat Foy Minneapolis, MN member-at-large for combined AL/MS, FL/GA region Dr. Martha Wallace Birmingham, AL PDA Dr. Dan Pihlstrom Portland, OR SK Dr. Lotta Persson Tyringe, Sweden FL/GA Dr. Paul Benjamin Miami, FL

8. A network about, with, and for practitioner-investigators and their patients Practical science done about, in, and for the benefit of “real world" clinical practice.

9. 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 9

10. 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. 10

11. Practitioner-investigators are engaged at every step of the process 11

12. Practitioner-investigators are engaged at every step of the process 12

13. Practitioner-investigators are engaged at every step of the process 13

14. Update on DPBRN studies as of May 2010 • 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” 14

15. Update on DPBRN studies as of May 2010 • 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” 15

16. Update on DPBRN studies as of May 2010 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” 16

17. “Research that works” = “win-win” for all involved 17

18. Benefits of particular interest to community health centers • 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

19. 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

20. 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

21. 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

22. 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

23. Keeping DPBRN transparenthttp://www.DPBRN.org 23

24. Thank you!

25. slides from this point forward will not be presented

26. How is PBRN research different from other types of research? 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

27. DPBRN Year 05 report - a lot of activity! • 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 27

28. What are we supposed to be accomplishing? • We have made a point of … • listening to a wide range of full-time practitioners • listening closely • listening often

29. Some comments from attendees at the Atlanta meeting 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.”

30. Practitioner-investigators are engaged at every step of the process 30

31. Benefits of particular interest to community health centers - can become part of the solution; cannot “drill our way out of this”