By Dr. Gregg H. Gilbert for the National Dental PBRN Collaborative Group, National Network Director
Practice-based research networks (PBRNs) have demonstrated that they can make major and unique contributions to improving clinical practice. They offer advantages both to research and quality improvement. They can move scientific advances into routine practice quickly, and they can bring practice-relevant topics onto the research agenda.
Ushering in a new era for oral health research, in 2005, the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health (NIH), funded three regional dental PBRNs for a seven-year period. By the end of their funding period, the regional PBRNs had conducted numerous studies with thousands of patients and hundreds of
practitioners on a broad range of topics. Because of the success of the regional PBRNs, in 2011, NIDCR announced that it would fund the dental PBRN initiative for an additional seven-year period; however, in this new phase, the
initiative would be funded as a single, unified national network and therefore no longer be funded as regional PBRNs. This new network, The National Dental Practice-Based Research Network (National
Dental PBRN), began operation in April 2012.
The Purpose of a National Network
The National Dental PBRN joins practitioners with academic researchers to develop and answer relevant research questions that can directly impact routine clinical practice. PBRNs are based on the understanding that the experience, insight, and practical wisdom of full-time clinicians and their patients are powerful means to advance the health of the population and address challenges encountered in clinical practice. The dental PBRN research context has changed the profession’s model for doing research by bringing practitioners and patients to the discussion table.
The National Dental PBRN seeks to foster a future in which research and quality improvement are done on a routine basis in everyday clinical practice, just because these things are what we do as a profession. To capitalize on the practicing community’s immense amount of practical clinical wisdom—which before the PBRN era was essentially ignored—the nation’s network is very intentional about engaging practitioners at every step of the research process. These steps include generating study ideas, developing protocols, implementing feasibility and pilot testing, collecting network-wide data, analyzing and interpreting data, making presentations, and publishing study results.
The Research-to-Practice Gap
The often-lamented research-to-practice gap refers to the delay between what research evidence suggests should be happening in routine clinical practice, and what is actually happening. This single gap is actually best dissected into three gaps.
The first can be a knowledge gap, where the effectiveness of a treatment approach is not known. This gap creates a need to conduct research studies to close that gap. The second can be a knowing gap, where the effectiveness of a treatment has been scientifically established, but practitioners are not aware of this knowledge. This knowing gap creates a need to more effectively disseminate that knowledge or evidence. The third can be a knowing-to-doing gap, in which knowledge is available and providers are aware of it, but they have not yet implemented the recommended changes. This type of gap is a result of inadequate implementation of evidence.
The National Dental PBRN seeks to do studies and other activities that will close all three components of the overall research-to-practice gap. The network offers a range of opportunities to dental schools and their faculty to participate in this effort.
- Faculty can enroll in the network as practitioners if they see patients on a regular basis outside of a student setting. In that role, they can experience the same broad range of benefits that other practitioners report.
- Nonpractitioner faculty can also enroll thereby receiving regular communications about network activities.
- Faculty can propose study ideas. To do so, the first step is to complete a brief Study Concept Template. The study concept is then reviewed by the network’s Executive Committee (the key decision-making body of the network, which is structured to make the network practitioner-driven). The proposed Study Principal Investigator (Study PI) is asked to attend that meeting via conference call. If the study is ultimately developed fully and approved, then the Study PI can receive funding via a subcontract between his or her institution and the network’s administrative center (University of Alabama at Birmingham). Typical items in such a subcontract would be salary support for the Study PI, travel costs to present scientific findings, and other costs that the institution would incur as a result of leading the study on behalf of the network. As part of its infrastructure funding, the network provides:
Dental schools may also serve as continuing education sites at which network faculty present findings from network studies, thereby creating additional opportunities for the schools to engage local alumni.
- Support for study design and biostatistical expertise,
- Access to trained research coordinators,
- Payments to practitioners and patients for study participation, and
- Access to a large and diverse group of practitioners and patients.
- Participation in the network by faculty can also foster faculty development in research, either as practitioners, Study PIs, or faculty who work with practitioners to develop study designs as part of a Study Team.
Referring to itself as “the nation’s network,” the National Dental PBRN seeks to become a prized national resource, capitalizing on the historic, unprecedented opportunity provided to the dental profession by the NIDCR to add to the scientific basis of clinical decision-making and to move this evidence into routine clinical practice. The network seeks to: (1) become the preferred avenue by which ideas are put to the test; (2) conduct studies that actually make a difference in how care is provided; (3) serve as a venue for testing methods for how best to move evidence into routine practice; (4) enhance opportunities for professional and inter-professional collaborations; (5) serve as a key source for what works, when, and for whom; (6) provide an opportunity for the profession to lead rather than to be led; (7) show patients that it is contributing to their well-being; and (8) enhance the public’s view of dentistry by showing the profession’s commitment to research and quality improvement.
Over the past seven years, practitioners have reported many benefits from participation in the network—from engaging staff in the excitement of discovery and quality improvement to increasing their practices’ stature among patients. To learn more about the network or to enroll at no cost, visit the network’s website. To direct your inquiry to the correct person, please send an email.
This work is supported by NIH grant U19-DE-22516. Opinions and assertions contained herein are those of the authors and are not to be construed as necessarily representing the views of the respective organizations or the National Institutes of Health.