Today, few general dentists implement the recommendations of evidence-based (EB) treatment guidelines even though relevant guidelines exist. Instead, dentists tend to use diagnostic and treatment methods acquired during their primary dental education. This reliance on old methods impedes translation of new research into practice. The long-term goal of our program of research is to promote the integration of research findings and EB interventions among practicing dentists (R01). The objectives of this proposal (R21) are to understand the behavior of practicing dentists and ancillary staff (=identify information barriers), develop prototypical informatics solutions based on this newly gained knowledge (=overcome these barriers) and deploy these solutions on a limited scale (=pilot study for instrument development). Results from this research will help us to refine hypotheses, establish feasibility and provide pilot data necessary for a follow-up (R01) study to compare the effectiveness of various implementations in a real-world dental practice setting. The proposed application has three Specific Aims.
In Aim1, we will identify information barriers to the implementation of research findings and EB interventions by presenting patient vignettes to dentists and by interviewing them about current treatment approaches, information barriers, and solutions to those barriers.
In Aim 2, we will generate a comprehensive list of informatics solutions customized to the patient at hand to support the integration of treatment guidelines into the practice workflow of general dentists.
In Aim 3, we will prototypically deploy the newly developed informatics solutions in a pilot study to practicing dentists, allowing us to develop an instrument for measuring the effectiveness of various implementations. The instrument will be tested for understanding and usability, reliability and validity. Using the instrument to sample study participants will allow us to determine the sample frame of the ultimate target audience. This work will address the third step of the ADA's policy on EB dentistry, which is "focused on translating the findings from systematic reviews for use by practitioners." Our program of research will contribute to the development of next-generation practice management systems. We believe that the informatics solutions we develop will overcome common information barriers and accelerate the advent of the "meaningful use" of electronic patient record systems in dentistry. We anticipate that our solutions will be useful in leveraging solutions for the integration of EB guidelines in similar practice settings as well.
Currently, dentistry lags behind medicine with respect to promotion of research findings and evidence-based (EB) knowledge in clinical settings. The proposed research will help redress this disparity by developing informatics solutions for efficient delivery of current EB information about better treatments to general dentists at chairside.
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