Sustainability and colleague influence of evidence-based change: National Dental PBRN [poster]
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Objective: Emerging evidence indicates clinicians participating in a practice-based research network (PBRN) are more likely to adopt research-supported treatment into their practices. Little evidence exists whether they sustain those practice patterns over time.
Methods: Our earlier work used multivariable logistic regression models to adjust for patient demographics, co-occuring diagnoses and clustering at the clinic, provider, and patient level, and compared restoration rates among 35 providers employed by HealthPartners Dental Group (HPDG) for newly diagnosed early stage caries. Prior analysis examined 2005 through 2009 with attention to a 2008 network meeting focused on early stage dental caries. That work indicated significant differences in treatment patterns according to level of PBRN engagement. Those with no PBRN involvement (N=6) had restoration rates that went from 93% (2005) to 88% (2008). Providers with high PBRN involvement (N=14) decreased use of restorations by 14% from 77% in 2005 to 63% in 2008 (p<.01). The current study explored the sustainability of these practice changes by including data from an additional two years, examining the period 2009-2011.
Results: Compared to 2008 (74%), restoration rates within HPDG declined significantly (2009: 63%, p<.01; 2010: 52%, p<.01; 2011: 48% p<.01) indicating a sustained PBRN impact. However, change differed by level of PBRN engagement. In 2009, there were significant differences in restoration rates among those with and those without PBRN involvement (59% versus 76%, p<.01). By 2011, practice patterns converged but remained significantly different (54% versus 59%, p<.01), suggesting best practice dissemination across providers.
Conclusion: National Dental PBRN participation is correlated with practice change, defined as significant decreases in restoration rates. The impact is most significant for providers most involved in relevant study and dissemination activities. Change that we observed in the last half of 2008 and 2009 continued in 2010-2011, supporting a conclusion of sustainability.