Associate Professor & Director, Dental Informatics Core
Cariology, Operative Dentistry & Dental Public Health
Leveraging Electronic Dental Record Data for Clinical Research in the National Dental PBRN Practices
During the last two decades, Practice-Based Research Networks were established in medicine and dentistry to promote translational research especially in small practice settings where most people seek care. However, anecdotal reports indicate that it is difficult to conduct long-term prospective clinical studies due to the high costs and workflow issues in practice settings. With the increasing availability of electronic dental record (EDR) data, we have the potential to utilize it for research specifically to assess treatment outcomes and support shared decision-making by clinicians and patients about treatment choices. My recent grant as study principal investigator through the NIDCR funded National Dental Practice-based Research Network (Network) 5U19DE022516 is the first nation-wide study that determined the feasibility of using EDR data from private practice settings for research. Through this project, I recruited 99 Network practices that used two EDR systems: Dentrix and EagleSoft. These two systems collectively hold more than 50 percent of the market share of EDRs in private practices. A multi-disciplinary team that included EDR vendors, software engineers, ontology experts, informatics and dental researchers, and dentists together developed a process to extract and analyze data from solo- and small group practices. Following the success of our research, the American Dental Association (ADA) is establishing a repository of EDR data for research and quality improvement purposes and since January 2019, I serve as a consultant for the ADA’s Dental Benefit Plan division to implement this project. We also established data quality metrics to assess the extent to which EDR data are complete and correct for the data to be appropriate for research use. Thus, this study established a strong multidisciplinary collaboration for future studies using practice level data enabling rapid translation of research data into practice. The first paper from this study that describes the data quality and their suitability for research is accepted for journal publication. This study also for the first time assessed the longevity of root canal treatments (RCT) and posterior composite restorations (PCR) performed in US private practice settings on a diverse patient population (including uninsured population) over a long time. As discussed in this presentation (https://www.youtube.com/watch?v=r3mJX6WQGFs time: 15:11-18:56, https://bit.ly/2kJBx6p), the medial survival time of RCT teeth was 10 years and significant differences were found in the survival time by insurance, crown placement and across the six regions. With regards to longevity of PCR, the median survival time was 4.58 years across the 99 practices and significant differences were found by age (in the video from time 20:46-22:43). However, we did not detect any clinically significant differences by gender, number of tooth surfaces treated, insurance and network region. Through this work, we have established a process to assess treatment outcomes performed in solo and small group practice settings and thus support clinicians to use their data for patient education and to enable their patients to make informed treatment decisions.