1. South Texas Oral Health Network
Co-Director: Rahma Mungia, DDS, MSc
Good evening everybody! My name is Rahma Mungia and I am the co-director of STOHN.

2. Overview Why do Research in Practices?
What is South Texas Oral Health Network (STOHN)?
Completed and Ongoing Studies in STOHN
How to Engage Community Dentists in Research?
Resources Available
Today I am here to talk to you about:
Why do Research in Practices?
What is South Texas Oral Health Network (STOHN)?
Completed and Ongoing Studies in STOHN
How to Engage Community Dentists in Research?
Resources Available

3. What is a practice?
Practice is defined as any clinical setting that provides comprehensive primary care services (acute or chronic illness and primary care)
The setting can be private or public, community-based, or institutionally based
Practice is defined as any clinical setting that provides comprehensive primary care services.
The setting can be private or public, community-based setting, or institutionally based.

4. Why do research in practices?
Sutton’s Law: “that’s where the majority of patients and problems are!”
Practices are the best place to study the prevention of health problems
Practices are a good place to study problems over time
Patients in practices are more representative of any clinical problem than those seen in hospitals
Willie Sutton was bank robber. When questioned by the police on why he robbed banks, he said “that’s where the money is!”

5. Dental Research
Dental research is continually discovering improved treatment methods and therapies
Dentists must stay current with changing therapies
Evidence-based practice has been shown to keep dentists up to date in order to provide the best care to their patients
Dental research is continually discovering improved treatment methods and therapies.
Dentists must stay current with changing therapies.
Evidence-based practice has been shown to keep dentists up to date in order to provide the best care to their patients.

6. “If we want more evidence- based practice, we need more practice-based evidence.”
Green LW and R. Glasgow, 2006
If we want more evidence-based practice, we need more practice-based evidence

7. SOUTH TEXAS ORAL HEALTH NETWORK

8. Co-Directors: Thomas Oates/Rahma Mungia
Formed 2008
Co-Directors: Thomas Oates/Rahma Mungia
Practice Facilitator: April Biasiolli
Goal:
Is to develop the research infrastructure for generating practical, timely information that can be used by dental practitioners to enhance the quality and efficacy of oral health care.
Mission: “Generate evidence that matters in dentistry”
It has been an eventful and progressive journey since we first began in 2008 under the auspices of the community translational science award.
The co-directors are Dr. Thomas Oates and myself.
The goal of the network is to develop the research infrastructure for generating practical, timely information that can be used by dental practitioners to enhance the quality and efficacy of oral health care.
Our mission is to generate evidence that matters in dentistry.

9. Board of Directors 6 Board members February, 2009 Private Practitioner
Academic Faculty
Felipe Morales
Kevin Donly
James Bone
Peggy Alexander
Javier Garcia
Kevin Scott
I would also like to thank our dedicated board members. Our board was formed in 2008 and comprises of 6 members.

10. 20 STOHN Members (16 practices)
Network Members
20 STOHN Members (16 practices)
Daniel Arredondo
Kimberly Koenig
Joshua Austin
Maria Howell
James Bone
Christopher Marlette
Jennifer Bone
Luiso Massa
Irma Cantu-Thompson
James Mazock
Cheryl Davis
Felipe Morales
Brandt Dotson
Christopher Perry
Veronica Garza
Richard Potter
Christina Garanzuay
Kevin Scott
Alicia Galvan
Emil Willmann
Finally I would like to thank our 20 dedicated network members who made STOHN happen! Thank you so much for your enthusiasm and participation in STHON studies.

11. Size and Diversity of the Patient Population in STOHN
Annual Patient Visits
4,000
Race/Ethnicity
Non-Hispanic White
Hispanic
African-American
Others 40 36 15 9
Age (%)
Children < 14
Adults 15-64
Adults >65 58 27
Gender (%)
Male
Female 60
Insurance Status (%)
Private Insurance
Medicare
Medicaid
No Insurance 47 6
Let us know look at the Size and Diversity of the Patient Population in STOHN.

12. STUDIES

13. What kinds of studies take place in practices?
Descriptive and observational studies
Intervention studies
Qualitative and mixed methods studies
Focus groups or in-depth interviews
Study ID:
DATE:
TITLE:
CLINIC NAME:
Questions
Answers
Do you offer tobacco cessation counseling services?
Do you bill for the tobacco cessation counseling services you provide?
Did you know that you can be reimbursed for tobacco cessation counseling services?
 YES  NO
if no, go to question #3
Card Study: use the card to record data within short time frame
Surveys
Intervention studies: Testing an hypothesized epidemiological cause-effect relationship by intervening in a population and modifying a supposed causal factor and measuring the effect of the change.

14. What are examples of STOHN studies?
Completed studies:
Prevalence of Undiagnosed Diabetes in Dental Offices
Health Literacy Card Study
Ongoing studies:
Barriers to Tobacco Cessation Counseling Services
Efficacy and Cost Effectiveness of Oral Cancer Screening Devices
Diabetes Assessment Card Study

15. Prevalence of Undiagnosed Diabetes Among Patients in Community-Based Dental Practices  
Purpose: Identify the prevalence of undiagnosed diabetes in dental offices.
Method:185 patients/ aged 35-65/8 dental clinics
Results: 36% (N=66) of patients were at high risk for Type 2 diabetes, but only 14% (N=26) had been diagnosed. Of the high-risk patients, 64% (N=42) were women and 49% (N=32) were Hispanic. 84% (N=53) of these patients were accessing health care services regularly.
Conclusions: The prevalence of undiagnosed patients at high risk of Type 2 diabetes is 31.1% despite regular medical care. 
Examine the potential for dental practices to offer undiagnosed diabetes patients a unique portal into medical care beyond the physician-centered settings.

16. Assessment of Dentists and Patients Willingness to Participate in Finger-Stick
Purpose: Assess the willingness of dentists and patients to participate in a study that will involve a finger-stick assessment of Blood Glucose Level.
Methods: 25 patients /8 dentists/single- question survey.
Timeline: Data collection will be completed by the end of April; data analysis will be completed by the end of May.

17. Health Literacy Card Study
The goal of the proposed study is to develop and test a practice-based intervention to improve oral health literacy and periodontal outcomes among consumers, ages years old, who are participating in a STOHN practice-based research network (PBRN) in San Antonio, Texas.
Purpose: To show the network’s/individual practices capacity to survey patients in the waiting room using a simple one- question form.
Method: Patients aged 45-75/ 13 dental clinics/ self reported patient card survey.
Results: 78 percent of the patients were interested in participating in a study that would help their practice create new ways to improve the patient’s understanding of dental information.
The data was used to support the Health Literacy Grant, submitted January, 2010.

18. Barriers to Tobacco Cessation Counseling in Dental Offices
Purpose: Determine barriers to dentists and physicians providing in-office tobacco cessation counseling, brainstorm solutions, and provide resources.
Methods: 6 dental and 6 primary care practices/focus groups.
 Results:
Concern about patients’ reactions
No Impact
“Chair time” that could be used otherwise
Billing Issues
Concern about patients’ reactions (anger, irritation, frustration)
Feeling that what they do doesn’t make an impact
It takes up “chair time” that could be used otherwise
They do not know how to bill for it and are concerned that if the insurance company declines to pay the patient will be billed.

19. Efficacy and Cost Effectiveness of Oral Cancer Screening Devices
Specific Aim #1: Design a multi-center randomized controlled clinical trial to estimate and compare the diagnostic accuracy of three screening regimens: a) visual and tactile oral examination, b) visual and tactile oral examination + Velscope, and c) visual and tactile oral examination + Trimara OCS 3000.
Specific Aim #2: Develop a tactical plan for the safe, rapid and rigorous execution and analysis of the proposed trial.
Specific Aim #3: Write a detailed Manual of Procedures (MOP) for conducting the proposed trial.

20. STOHN Convocation
Research priorities were developed at the STOHN Convocation Meeting. Members brainstormed ideas and voted on their top five priorities. These were:
Relationship between wound healing, Implant integration and bisphosphonates
Sudden tooth decay in elderly population
Endodontic failure associated with obturation materials and techniques
Controversy over restorative material
Failure of in office CAD-CAM crowns vs. traditional gold PFM crowns

21. How to generate a research question?
I wonder if ____ is related to ____?
Why do patients with ____ usually present with ____symptom?
Are patients with ______condition more likely to have/develop/present with _____________?
How common is __________ in my patient population?

22. ENGAGING COMMUNITY DENTIST

23. How do I engage community dentists in the research effort?
Publish Scientific Article
Community Dentist
Community needs to be engaged in the development of the research question, implementation of the research project, analysis of the results and/ or dissemination of the findings to community stakeholders. Community engagement is an important element of the successful translation of research from bench to bedside and community.
Research Funding
Research Project
SUCCESS!

24. What are the steps of collaborative research I should know about?
Groundwork for Partnership
Identify research area
Generate study questions
Design and implement study
Analyze and interpret data
Implement results
Disseminate findings
Involving community partners can begin in the earliest steps of the research process.
Early engagement helps studies encounter fewer logistical problems and have real and immediate relevance to the community.

25. What do I need to know to obtain funding for collaborative research?
Funding is scarce for relationship building
Start with a small pilot study and use the preliminary data in a grant application for a more ambitious study
NIH and AHRQ recognize the importance of PBRNs and are now requiring that you meaningfully engage the community
Practice-based research partnerships take time to develop and funding is usually scarce for the time it takes to build these relationships.
Begin with smaller studies that employ fewer resources and are easier to fund, moving on to larger.
The promising news is that, increasingly, major foundations and federal funders recognize the importance of practice-based research, and more funds are being allocated to practice-based research than ever before.
Agency for Healthcare Research and Quality

26. Funding to build relationships with clinicians
What are the challenges of collaboration I should think about as I consider research collaborated with community dentists?
Funding to build relationships with clinicians
Time needed for collaborative planning
Negotiating between your own research agenda and the clinicians’ needs
Some of the obvious obstacles to progress in this area are the time and funding required to establish and maintain mutually beneficial relationships.
Collaborative relationships often require a shift from investigator-driven study designs to designs that incorporate meaningful and relevant outcomes and outcomes that overlap with quality improvement efforts clinicians and clinic settings will value.

27. What options for research partnerships with community-based dentists should I know about?
Participatory Engagement
Clinician serves as co-investigator
Supportive Engagement
Gain input from clinicians on research question, study designs and implementation protocols
Minimal Engagement
Contact clinicians to assist in recruiting of patients for a fully designed and funded study with little input from clinicians

28. What administrative mechanisms should I know about when setting up a research partnership with community clinicians?
Use the PBRN Resource Center housed at the UT Health Science Center to assist you with:
Recruitment of clinical sites
Human Subjects Protection Training
Training of clinicians and staff
Letters of support/MOUs
Marketing

29. What are the next steps?
Apply for CTSA pilot funds to conduct a small research project (no more than 3 month project) in STOHN.

30. How do I learn More?
Dr. Rahma Mungia at or at
Visit our website. hn.html

31. Thank you!
Also I would like to point out that we have quarterly newsletters and brochure if you are interested in grabbing one.