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Practice change toward better adherence to evidence-based treatment of early dental decay in the National Dental PBRN

机译:改变实践以更好地遵守美国国家牙科PBRN的循证治疗早期龋齿

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Background 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? Methods 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. Results In 2005, restoration rates were high (79.5%), decreased to 47.6% by 2011 (p?
机译:背景技术大量的国家投资帮助发展了医学和牙科领域基于实践的研究网络(PBRN)。很少有证据检查这些努力的翻译影响,以及PBRN的参与是否对应于更好地采用最佳可用证据。这项研究解决了这一知识差距,并研究了使用相同的循证指南的PBRN参与者和非参与者之间早期龋齿的变化。这项研究探讨了以下有关PBRN参与的问题:参与PBRN的提供者的实践模式是否与当前证据更加一致?提供者参与PBRN是否增加与现有证据的一致性?参与PBRN活动的提供者是否向其同事传播知识?方法采用Logistic回归模型对诊所和服务提供者进行聚类调整,在大型员工模型实践中比较了35位提供者从2005-2011年的恢复(牙科充填)率。确定了所有早期龋齿(龋齿)和同时出现的龋齿的新代码。根据诊断之日起长达6个月的规范确定治疗方案。提供商PBRN参与度由研究参与度和会议出席率决定。结果2005年,恢复率很高(79.5%),到2011年下降到47.6%(p?<?0.01),并且PBRN参与程度有所不同。 2005年,与未参与服务的提供者相比,参与服务的提供者使用修复的可能性较小(73.1%对88.2%; p 0.01)。从2005年到2008年,PBRN参与度较高的提供者将修复体的使用减少了15.4%(2005:73%,2008:63%; p <0.01)。没有PBRN参与的提供者的使用量仅减少7.5%(2005:88%,2008:82%; p?= ?. 041)。在5月的PBRN会议之后的2008年下半年,与会的与会者减少了7.5%的修复,而未与会人员中的修复率为2.4%(OR ==。64,p?<0.01.01)。结论根据实际临床数据,PBRN参与与实践改变相关,与当前有关早期龋齿治疗的证据一致。 PBRN参与的影响对于参与度最高的提供商最为重要,并且与对未参与PBRN的同一诊所的提供商的溢出效应一致。 PBRN可以产生相关证据并加快将其转化为实践。

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