Rindal Donald Brad, Flottemesch Thomas J, Durand Emily U, Godlevsky Olga V, Schmidt Andrew M, Gilbert Gregg H
Implement Sci. 2014 Dec 2;9:177. doi: 10.1186/s13012-014-0177-x.
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?
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.
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).
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.
国家的大量投资推动了医学和牙科领域基于实践的研究网络（PBRN）的发展。几乎没有证据考察过这些努力的转化影响，以及PBRN的参与是否与更好地采用最佳现有证据相对应。本研究填补了这一知识空白，考察了有机会获取相同循证指南的PBRN参与者和非参与者早期龋齿的变化情况。本研究就PBRN参与情况探讨了以下问题：参与PBRN的医疗服务提供者的实践模式是否与当前证据更一致？医疗服务提供者参与PBRN是否会提高与当前证据的一致性？参与PBRN活动的医疗服务提供者是否会向同事传播知识？
采用逻辑回归模型，对诊所和医疗服务提供者层面的聚类进行调整，并比较了一家大型员工模式诊所中35名医疗服务提供者在2005 - 2011年期间的修复（补牙）率。识别出所有早期龋齿（蛀牙）和并发龋齿的新编码。治疗情况由诊断日期后6个月内出现的编码确定。医疗服务提供者的PBRN参与情况由研究参与度和会议出席情况确定。
2005年，修复率很高（79.5%），到2011年降至47.6%（p < 0.01），且因PBRN参与程度不同而有所差异。2005年，参与PBRN的医疗服务提供者与未参与的相比，使用修复手段的可能性较小（73.1%对88.2%；p < 0.01）。PBRN参与度高的医疗服务提供者在2005年至2008年期间修复手段的使用减少了15.4%（2005年：73%，2008年：63%；p < 0.01）。未参与PBRN的医疗服务提供者仅减少了7.5%（2005年：88%，2008年：82%；p = 0.041）。在2008年5月PBRN会议后的下半年，参会者的修复手段减少了7.5%，而非参会者减少了2.4%（OR = 0.64，p < 0.01）。
基于实际临床数据，PBRN参与与实践变化相关，这与当前关于早期龋齿治疗的证据一致。PBRN参与对参与度最高的医疗服务提供者影响最为显著，并且对未参与PBRN的同诊所医疗服务提供者产生了溢出效应。PBRN能够生成相关证据并加速转化为实践。
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