Association for Public Policy Analysis & Management

The National Institute of Dental and Craniofacial Research (NIDCR), one of the institutes in the US National Institutes of Health, established a dental practice-based research network (PBRN) in 2005 with a goal of contributing to clinical decision-making among community-based practitioners. More than 6500 dental practitioners have joined the network.  PBRN members identify clinical topics (for example, how to manage a broken tooth or when to intervene to fill a small cavity), a research protocol is developed with academic and other partners, and data are collected from the practitioners, their records, and, sometimes, their patients. About thirty studies have been developed to date and many have been completed. Study results have been disseminated in numerous publications in peer-reviewed journals.

A stable, comprehensive, and predictable infrastructure has contributed to the success of the program, which represents a federal investment over two cycles of funding (2005-2012, 2012-2019) of about $140 million US (nominal). Infrastructure funds support the following activities: recruit and organize practitioners; identify and select research topics of interest to practitioners; attract and engage academic investigators; convene meetings of multiple stakeholders to develop research protocols;  facilitate regulatory, monitoring, and clinical oversight; hire, train and provide access to research coordinators; recruit and train dental practitioners to conduct studies in their practices;  provide data management and analysis; and prepare or assist in the publication and dissemination of study findings.

In the first cycle, an international collaboration was built into the budget and the international members had access to the full spectrum of the research infrastructure funded by the NIDCR.  In the second cycle, a professor at a Japanese dental school self-identified as a potential collaborator and subsequently established a dental PBRN in Japan.  No funding was available from the NIDCR to support the Japan PBRN; however, the US dental PBRN was able to provide some resources at no cost and a US dental school that was specifically invested in expanding its global outreach also provided a modest amount of resources.  Small amounts of public and private funds in Japan were available to the Japanese professor to support the Japan dental PBRN. 

One way that costs were minimized for the Japan PBRN was that the Japan PBRN adapted already completed or implemented studies from the US PBRN.  Resources were devoted in the US only but not in Japan to designing a study, creating and pre-testing initial data collection forms, and writing the investigator’s brochure and other documents. There were also limitations in using a shared infrastructure; because the research coordinator support was less available to the Japan PBRN, longitudinal clinical studies were not feasible for the Japan PBRN.  In this paper, we explore, from a policy perspective, the necessary and sufficient conditions under which an existing research infrastructure in the US can support PBRN research in another country such that the peer reviewed science literature and the clinical decision-making by practitioners improves or is enhanced in both countries.