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  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 I am delighted to have this opportunity to participate in this CyberSeminar on Practice-based Research and to have an opportunity to share with you the experiences of VADER, VA Dentists Engaged in Research, which was established as an oral health research entity in 2007 through the VA Office of Dentistry. 12/08/10
  • The VA Office of Dentistry has established three entities to support its mission of provide excellent oral health care to Veterans. These are the Quality Group, the VADER PBRN, and the an Educational Initiative. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • The VA Office of Dentistry has established three entities to support its mission of provide excellent oral health care to Veterans. These are the Quality Group, the VADER PBRN, and the an Educational Initiative. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • The VA Office of Dentistry has established three entities to support its mission of provide excellent oral health care to Veterans. These are the Quality Group, the VADER PBRN, and the an Educational Initiative. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • The VA Office of Dentistry has established three entities to support its mission of provide excellent oral health care to Veterans. These are the Quality Group, the VADER PBRN, and the an Educational Initiative. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • The VA Office of Dentistry has established three entities to support its mission of provide excellent oral health care to Veterans. These are the Quality Group, the VADER PBRN, and the an Educational Initiative. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • The VA Office of Dentistry has established three entities to support its mission of provide excellent oral health care to Veterans. These are the Quality Group, the VADER PBRN, and the an Educational Initiative. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • The VA Office of Dentistry has established three entities to support its mission of provide excellent oral health care to Veterans. These are the Quality Group, the VADER PBRN, and the an Educational Initiative. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 I am delighted to have this opportunity to participate in this CyberSeminar on Practice-based Research and to have an opportunity to share with you the experiences of VADER, VA Dentists Engaged in Research, which was established as an oral health research entity in 2007 through the VA Office of Dentistry. 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 Oral Health Research Officers facilitate the conduct of studies at each of their locations and sites. 12/08/10
  • Our VA mission stated concisely is to provide excellence in health care. The VA has a rich and distinguished research history. Research has always been an important and integral aspect of performing the health care mission in the VA. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • The VA Office of Dentistry has established three entities to support its mission of provide excellent oral health care to Veterans. These are the Quality Group, the VADER PBRN, and the an Educational Initiative. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • The group draws above expertise in the VA community as well as from experts within the community. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • The VADER network was modeled after the three large NIH funded practice-based research networks which were established in 2005 VA PCS Grand Rounds Nov 23 2009 12/08/10
  • These groups working closely together develop a particular synergy which enables VA providers and VA leadership the opportunity to make improvement in the quality of care delivered to veterans VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 By using DRM to its fullest potential a great deal of information is at our fingertips 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 VADER is presently engaged in three initiatives and projects 12/08/10
  • The first of these studies is a quality survey the is attempting to determine how VA dentists diagnose and treat dental care, something that is fundamental to the practice of dentistry. Earlier research in this area suggests wide variability in how dental caries are diagnosed and treated VA PCS Grand Rounds Nov 23 2009 12/08/10
  • This survey will also provide insights in to how dentist restore teeth using dental amalgam, composite resins, or other material. As an aside, the FDA this week issued a statement that dental amalgam remains a safe material for restoration of teeth. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 VADER has partnered with investigators from UAB, the Iowa City VA , and VA Pharmacy on a VA funded study to evaluate the risk factors for osteonecrosis of the jaws or ONJ. ONJ appears to be more prevalent in patients treated with a class of drugs call bisphosphonates which are used to treat low bone density, osteoporosis and certain malignancies and metastases of these malignancies to bone. An example of such a drug would be Fosamax. Some dentists have concerns about treating patients on bisphosphonates because of the possibility that the patient may develop ONJ after a simple dental procedure such as periodontal treatment or a tooth extraction. This retrospective case control study aims to determine whether or not dental procedures pose a risk to patients on biphosponates. One of the issues that has slowed the deployment of this important patient safety study is IRB approval. Regrettably the VA Central IRB has chosen not to become involved in this VA funded project and hence IRB approval must be obtained at over 15 separate locations. Ironically this additional challenge resulting for the need to obtain multiple IRB approvals may pose a safety risk by delaying the dissemination and implementation of vital information to clinicians. 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 VADER is developing a study that will evaluated the longevity and survival of teeth treated with root canals in the VA. The literature suggests that endodontic treatment in and unto itself is 90% successful. However tooth survival may be contingent on not only having a successful root canal but also whether or not the tooth is properly filled or restored after the procedure. This project will leverage rich extant VA data collected over the past several years to provide guidance to VA practitioner when deciding on which forms of treatment are best for their patients and also to VA leadership in the allocation and targeting of resources for the treatment of common dental conditions. 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 VADER is developing a study that will evaluated the longevity and survival of teeth treated with root canals in the VA. The literature suggests that endodontic treatment in and unto itself is 90% successful. However tooth survival may be contingent on not only having a successful root canal but also whether or not the tooth is properly filled or restored after the procedure. This project will leverage rich extant VA data collected over the past several years to provide guidance to VA practitioner when deciding on which forms of treatment are best for their patients and also to VA leadership in the allocation and targeting of resources for the treatment of common dental conditions. 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 VADER is developing a study that will evaluated the longevity and survival of teeth treated with root canals in the VA. The literature suggests that endodontic treatment in and unto itself is 90% successful. However tooth survival may be contingent on not only having a successful root canal but also whether or not the tooth is properly filled or restored after the procedure. This project will leverage rich extant VA data collected over the past several years to provide guidance to VA practitioner when deciding on which forms of treatment are best for their patients and also to VA leadership in the allocation and targeting of resources for the treatment of common dental conditions. 12/08/10
  • VADER has been instrumental in promoting the establishment of a joint DOD-VA Cranial Implant Center at the future Walter Reed National Military Medical Center. This Cranial Implants are designed using CADCAM techniques at the Walter Reed Army Medical Center and then fabricated by Navy Maxillofacial Prosthodontists at the present National Naval Medical Center. The materials used include denture materials , titanium and others. Plans are to integrate this Cranial Implant Center with the pending VA Implant registry so that these patients can be effectively followed and managed. This also presents a unique opportunity for outcomes research on these procedures and the material being used to fill this large cranial defects. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VADER with skilled and expeditious assistance of VA General Counsel is about to finalize an agreement with the American Dental Association that will enable VA dental professionals to participate in the national ADA Professional Products Review Program. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VADER with skilled and expeditious assistance of VA General Counsel is about to finalize an agreement with the American Dental Association that will enable VA dental professionals to participate in the national ADA Professional Products Review Program. VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 VA Research Update AADR GAAC Oct 14 2008 VADER also has several additional projects under consideration., all of which are highly clinical relevant to VA practitioners and the patients they treat daily. 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 12/08/10
  • VA PCS Grand Rounds Nov 23 2009 Thanks for your attention and I would be delighted to entertain your questions as time permits. My preferred email is at NIH but I am also in VA outlook. 12/08/10
  • Transcript

    • 1. Dental Practice-Based Research Donald J. DeNucci D.D.S., M.S. Research Consultant/VA Office of Dentistry Program Officer/NIH/Practice-based Research Networks
    • 2. Dental Practice-based Research: Conducted in the “real world” of clinical dentistry and designed to improve oral health and to support the adoption of evidence-based clinical practice Dental Practice-Based Research
    • 3. <ul><li>Practice-based research is research conducted in clinical practices by practitioners/clinicians </li></ul><ul><li>Designed to answer questions practitioners face in the routine care of their patients. </li></ul>What is Practice-based Research?
    • 4. <ul><li>Practice-based research holds great potential for answering clinical questions and expediting the translation of research findings into clinical practice. </li></ul>What is Practice-based Research? (cont.)
    • 5. <ul><li>A group of practitioners engaged in practice-base research constitutes a Practice-based Research Network (PBRN). </li></ul>What is a Practice-based Research Network (PBRN)?
    • 6. Institutionally-based Research Publications Policy Development Clinical Guidelines
    • 7. Analysis of Data Generated by Patient Care Policy Development Clinical Guidelines Publications
    • 8. Practice-based Research Publications Policy Development Clinical Guidelines
    • 9. <ul><li>Practice-based research began when small groups of European medical practitioners began sharing information pertinent to patient care and clinical outcomes </li></ul><ul><li>These early precursors to today’s practice-based research networks can be traced back to the European sentinel networks of the 1970’s. </li></ul>History of Practice-based Research
    • 10. <ul><li>This sentinel model soon took hold in the United States as the Ambulatory Sentinel Practice Network (ASPN) </li></ul><ul><li>Followed closely by the establishment of the Pediatric Research in Office Settings (PROS) in 1984 </li></ul>History of Practice-based Research (cont.)
    • 11. <ul><li>Currently there are over 120 primary care PBRNs known to be active in the U.S. which include about 20,000 practices of pediatrics, family medicine, and general internal medicine located in all 50 States </li></ul><ul><li>These practices provide care for more than 20 million Americans (Agency for Healthcare Research and Quality 2008). </li></ul>History of Practice-based Research (cont.)
    • 12. <ul><li>The dental profession has only recently recognized the value of practice-based research with the establishment of the Community Research for Oral Health Wellness Network (CROWN) in 2001 </li></ul><ul><li>NIDCR/NIH funded the establishment of three large dental practice-based research networks in 2005. </li></ul>History of Practice-based Research (cont.)
    • 13. NIDCR Dental Practice-Based Research Networks <ul><li>Cooperative Agreements </li></ul><ul><li>Awarded 5/01/2005 </li></ul><ul><li>$75 million over 7 years </li></ul><ul><li>Awardees </li></ul><ul><li>NYU PEARL Network </li></ul><ul><li>Universities of Alabama / Florida DPBRN Network </li></ul><ul><ul><li>Permanente Dental Associates </li></ul></ul><ul><ul><li>Health Partners </li></ul></ul><ul><ul><li>Georgia </li></ul></ul><ul><ul><li>Mississippi </li></ul></ul><ul><ul><li>Scandinavia </li></ul></ul><ul><li>Universities of Washington / Oregon NW PRECEDENT Network </li></ul><ul><li>TransPBRN entity comprising all three networks CONDOR Network </li></ul>
    • 14. <ul><li>Engages over 700 practitioners in several diverse geographic regions </li></ul><ul><li>Conducting or completed over 30 studies including a CONDOR case-control study of ONJ </li></ul><ul><li>Produced several manuscripts including the first book chapter on practice-based research* </li></ul><ul><li>Multiple abstracts, symposia, and invited presentations </li></ul>*DeNucci DJ and CONDOR Dental Practice-Based Research Networks. “ Dental Practice-based Research”. Clinical Research in Oral Health. Eds. Gainnobile, Burt, and Genco. Wiley Blackwell. 2010. 265-30
    • 15. Snapshot of Dental PBRNs’ Current Membership, by State
    • 16. <ul><li>Effectiveness of various strategies for the diagnosis of dental caries, periodontal disease, and oral cancer </li></ul><ul><li>Effectiveness of strategies to prevent progression of caries and periodontal disease </li></ul><ul><li>Natural history of untreated oral conditions, such as partially erupted third molars or cracked teeth </li></ul><ul><li>Effectiveness of interventions for treating and managing periodontal disease and caries </li></ul>Examples of the types of clinical studies being conducted by the NIDCR Funded PBRNS:
    • 17. <ul><li>Assessing variations associated with the delivery of dental health care </li></ul><ul><li>Assessing patient compliance with treatment recommendations </li></ul><ul><li>Effectiveness of various strategies for managing acute and chronic orofacial pain </li></ul><ul><li>Assessing the outcomes of various treatments such as endodontic therapy, dental implants, and other prosthetics and restorative modalities </li></ul>Examples of the types of clinical studies being conducted by the NIDCR Funded PBRNS (cont.)
    • 18. NIDCR PBRN Research Activities Year Five <ul><li>DPBRN: Studies are focusing on treatment strategies for treating early carious lesions, patient satisfaction with dental restorations, reasons for replacing dental restoration, diabetes screening, smoking cessation </li></ul><ul><li>PEARL: Studies are focusing on treatment strategies for advanced dental caries, survival of endo treated teeth , sensitive teeth, analgesic prescribing practices, periodontal disease diagnosis, oral cancer screening </li></ul><ul><li>PRECEDENT: Studies focusing on caries risk assessment, dental pulp capping, wisdom tooth removal, orthodontic anchorage devices, white spot lesions (early caries) </li></ul>
    • 19. VA PRACTICE-BASED RESEARCH NETWORK
    • 20. <ul><li>Deployed in September 2007 </li></ul><ul><li>A virtual network open to all 750+ VA Dental Professionals </li></ul><ul><li>Governed by an executive committee of “volunteers” composed of VA practitioners, researchers, IT experts, educators, residents, and fellows </li></ul>VA Dental Practice-Based Research Network (VADER)
    • 21. <ul><li>204 dental clinics VA wide </li></ul><ul><ul><li>127 facilities (hospitals) </li></ul></ul><ul><ul><li>77 outpatient clinics </li></ul></ul><ul><li>Oral Health Research Officers (OHRO) </li></ul><ul><ul><li>44 Officers: Certified VA Researchers VA wide </li></ul></ul><ul><ul><ul><li>37 Dentists </li></ul></ul></ul><ul><ul><ul><li>7 Dental Hygienists </li></ul></ul></ul>VADER Participants
    • 22. <ul><li>Our Mission... The mission of the Veterans Healthcare System is to serve the needs of America&apos;s veterans by providing primary care, specialized care, and related medical and social support services. </li></ul><ul><li>To accomplish this mission, VHA needs to be a comprehensive, integrated healthcare system that provides excellence in health care value, excellence in service as defined by its customers, and excellence in education and research ,……… </li></ul>VA Mission Statement
    • 23. <ul><li>VA OOD Quality Group </li></ul><ul><li>VA OOD Education Initiative </li></ul><ul><li>VA Dental Practice-based Research Network (PBRN) </li></ul>VA Office of Dentistry (OOD) Integrated approach to research, education, and quality measures
    • 24. <ul><li>Mission is to improve the oral health of veterans by promoting clinical practice based on the best evidence available </li></ul><ul><li>Develops Quality Indicators and Scorecards </li></ul><ul><li>Develops Information Papers </li></ul><ul><li>Develops Clinical Guidelines </li></ul>VA OOD Quality Group
    • 25. <ul><li>Mission is to improve the oral health of veterans by enhancing the translation and implementation of evidence into clinical practice </li></ul><ul><li>Provides monthly VA wide webinars on topics of interest to the VA Dental Team </li></ul><ul><li>Maintains a VA website with educational materials, archived webinars, and links to educational resources for Program Directors and others </li></ul>VA OOD Education Group
    • 26. <ul><li>Mission is to conduct research and provide answers to the questions facing VA Dentists in their daily practices </li></ul><ul><li>Strengthen the knowledge base for making clinical decisions. </li></ul><ul><li>Provide data to the VA Quality Group to assist them in addressing issues of greatest importance to the oral health of veterans </li></ul><ul><li>Provide information to the Educational Group to guide the development of education and training </li></ul><ul><li>for the VA Dental Team </li></ul>VA Dental Practice-based Research Network
    • 27. Improved Veteran Oral Health Quality Group VADER PBRN Education Group Informs Oral Health Providers VA Leadership Informs Informs Integrated Approach to Research, Education, and Quality Care
    • 28. <ul><li>Primary objectives : </li></ul><ul><ul><li>Conduct clinical studies to improve the health of Veterans </li></ul></ul><ul><ul><li>Emphasize effectiveness of oral health treatment and disease prevention </li></ul></ul><ul><ul><li>Facilitate clear and clinically meaningful outcomes </li></ul></ul><ul><li>Secondary objectives: </li></ul><ul><ul><li>Surveillance: Provide data on disease and treatment trends </li></ul></ul><ul><ul><li>Obtain estimates of the prevalence of less common conditions </li></ul></ul>VA Dental Practice-Based Research Network (VADER)
    • 29. <ul><li>Research Ideas: </li></ul><ul><ul><li>Stimulated by the clinical challenges faced by VA practitioners </li></ul></ul><ul><ul><li>Generated by practicing dentists and dental hygienists (i.e. practitioner - investigators) </li></ul></ul><ul><ul><li>Accepted from sources outside the VA PBRN (academia, individuals, etc…) </li></ul></ul>Dental Practice-Based Research Network in the VA
    • 30. <ul><li>A virtual network with no defined budget and staffed by volunteer VA dental professionals! </li></ul><ul><li>The first VA practice-based research network! </li></ul>Unique Aspects of the VADER PBRN
    • 31. <ul><li>STRENGTHS </li></ul><ul><li>Electronic Health Records </li></ul><ul><li>Uniform Practice Environment </li></ul><ul><li>Relatively Stable Research Population </li></ul><ul><li>Access to the superb VA Research Culture </li></ul><ul><li>Potential Access to the VA Central IRB </li></ul>Establishing A Research Network in the VA
    • 32. VA Dental Record Manager Module: CPRS
    • 33. <ul><li>CHALLENGES </li></ul><ul><li>Integration of research into a patient care environment </li></ul><ul><li>Providing incentives to participate in research </li></ul><ul><li>Managing fluctuations in fiscal and other support resources </li></ul>Establishing A Research Network in the VA
    • 34. <ul><li>VADER Study One: Assessment of Caries Diagnosis and Caries Treatment </li></ul><ul><li>Risk factors for ONJ in Veterans </li></ul><ul><li>Survival Root Canal Treated Teeth </li></ul><ul><li>Xerostomia Treatment Survey </li></ul><ul><li>VALPLAST Prosthodontic Survey </li></ul><ul><li>Oral Cancer Screening </li></ul><ul><li>VA/DOD Registry of Cranial Implants </li></ul><ul><li>ADA Professional Products Review </li></ul>VADER PBRN Research Portfolio Projects in development or deployed
    • 35. A Quality Survey VADER Study One: Assessment of Caries Diagnosis and Treatment
    • 36. A Quality Survey VADER Study One: Assessment of Caries Diagnosis and Treatment
    • 37. <ul><li>Retrospective Case-Control study of ONJ in Veterans (VA funded) </li></ul>Osteonecrosis of the Jaw: VADER/UAB/ IOWA City VA/ VA Pharmacy
    • 38. <ul><li>Endodontic Outcomes Study </li></ul>VADER PBRN Research Portfolio Studies in Development
    • 39. <ul><li>Xerostomia Survey </li></ul>VADER PBRN Research Portfolio Studies in Development
    • 40. <ul><li>Prosthetic replacement of teeth </li></ul>VADER PBRN Research Portfolio Studies in Development
    • 41. VA Cranial Implant Registry: A Joint VA / DOD project
    • 42. ADA Professional Product Review (PPR) – VADER
    • 43. <ul><li>Evaluation of dental products and equipment by VA Dental Professionals </li></ul><ul><li>Provided by the American Dental Association; hence no direct contact with industry </li></ul><ul><li>Evaluated in the real-world environment of VA clinical practice </li></ul><ul><li>Potential to inform VA acquisition decisions and the oral health community in general </li></ul>ADA Professional Product Review (PPR) – VADER
    • 44. <ul><li>Electric Dental Handpieces (Drills) </li></ul><ul><li>Shade Guides </li></ul>ADA Professional Product Review (PPR) – VADER
    • 45. <ul><li>Web/computer based smoking cessation study </li></ul><ul><li>Implant outcomes study </li></ul><ul><li>Implact of fluoride prescriptions and treatments on dental caries in Veterans </li></ul>VADER PBRN Research Portfolio Studies under Consideration
    • 46. Integrated Approach to Research, Education, and Quality Care Improved Patient Oral Health Quality Group Education Research PBRN
    • 47. Donald J. DeNucci, D.D.S., M.S. Research Consultant/VA Office of Dentistry Program Officer/NIH/Practice-based Research Telephone: 301-451-5096 Preferred E-mail:   [email_address] VA Outlook: [email_address] VA Office of Dentistry (OOD) Integrated approach to research, education, and quality measures

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