Digital Access to the World’s Literature: PHIA

A Blueprint to Integrate Evidence with Practice

Karen Dahlen, Project Consultant Elaine Martin, Director

New England Region NN/LM Lamar Soutter Library

University of Massachusetts Medical School

Introduction

Why This Project : Goals & TechnologyRelationship to National /State InitiativesSelected Resources Tied to Sources of EvidenceWork Within Existing Environment

Why This Project?

Unequal access to trusted library resources

Public Health Departments have lost in-house libraries, budget, and staff

Library models are in constant change; many caught in dated practices and

licenses dictate access policies.

The Council on Linkages Between Academia and Public Health Practice (June 11, 2009)

Competencies Defined By PHF/Council on Linkages

Project Tied to Competencies

Analytic/Assessment Skills› References sources of public health data and

information.› Uses information technology to collect, store,

and retrieve data.› Utilizes data to address scientific, political,

ethical, and social public health issues.

Policy Development/Program Planning Skills

› Analyzes information relevant to specific public health policy issues

Public Health Sciences Skills › Relates public health science skills to the

Core Public Health Functions.› Conducts a comprehensive review of the

scientific evidence related to a public health issue, concern, or intervention.

› Retrieves scientific evidence from a variety of text and electronic sources.

Knowledge Informatics› Improve access to trusted resources

directly to the desktop.› Describe relationships and functionality

of e-resources to core public health functions/interests.

› Introduce specific types of resources, e.g., coding and classification tools.

Informatics Skills› Introduce interoperable features that

support public health work, e.g., guidelines, calculators, connectivity to trusted public sites; advanced search capability/filters.

› Use of Citation Management Program to save, store & reuse information.

› Train on use of topical alerts as a education tool.

Digital Library for Public Health Supports National & State Public Health

Initiatives

Maryland DHMH Health Initiatives Health Disparities(sexual minorities)  

  Preventive Services ACA*

Routine HIV screening Immigrant Health

Undocumented individuals under ACA Drug Resistant Disease which

impacts Impact on TB, STI (plus others)

Health Care Reform and Interpersonal Violence/Domestic Violence Screening/Identification

Infectious DiseasesHepatitis C Virus (HCV)HIV Infections--HIV and HCV Co-Infection

*ACA –Affordable Care Act

Goals of the Project

Identify core, useful, trusted e-resources to State Departments of Health to improve evidence-based practice.

Provide direct access to subscribed + resources through an organized “digital library” page.

Promote ubiquitous access based on IP authentication and enterprise licensing.

Train on resources & tools related to scientific literature review to support evidence-based practice.

Monitor and update aspects of evaluation plan (data model)

Suite of Technology & Tools

IT authentication provides direct access to full-text;

SharePoint (Web application) is utilized to manage access when staff is located distant from main site;

NLM’s linkout technology improves connectivity to full-text;

E-Book interoperability with trusted resources saves time and energy.

Relationship of “Trusted Resources” to Sources of Evidence

Scientific literature in systematic reviews Scientific literature in one or more journal articles Public health surveillance data Program evaluations Qualitative data

› Community members

› Other stakeholders Media/marketing data Word of mouth Personal experience

Objective

SubjectiveFrom: Evidence-Based Public Health, A Course in Chronic Disease Prevention

Ross C. Brownson PhD

Work Within Existing System Environment

Incorporate system strengths of existing government agencies: NLM, CDC, NAL.

Partnerships with libraries and agencies to facilitate timely information.

Resources (both licensed and freely) integrate major health findings into routine work.

Resources support improved practice and nurture career pathways for the public health workforce.

Training encourages use of scientific literature to support work related processes.

Enterprise licensing provide cost efficiencies.

MethodsOverall Project Plan Resources & Tools Currently Being TestedPartnerships & Digital Libraries in Place

Training Agenda/Trainings HeldOngoing Evaluation Processes

Digital Library Resources Relate the World’s Literature to Practice

To identify “core” trusted library resources available directly through a digital library interface. identified through benchmarking, direct requests, wish lists, and searches.

Resources not directly available are subsidized through participating National Library of Medicine Network Members.

Digital Library

PHD Site

Alternate

Article Delivery

via Librarie

s

Timely Information in Support

of Evidence-BasedPublic Health

Practice

PHIA Public Health Dept/Library Partners

State Public Heath Department Partners

Hospital /Academic Library Partners

AK Alaska Division of Public Health (AKDH) Univ of Alaska (Anchorage) Medical Library

AR Arkansas Department of Health (ADH) Univ of Alabama Medical Sciences Library

CO Colorado Department of Health & Environment

Poudre Valley Health System Library

CT Connecticut Public Health Department University of Conn Maynard Stowe Library

HI Hawaii Department of Health University of Hawaii Medical Library

IN Indiana State Department of Health Ruth Lily Medical Library, Indiana University

KY Kentucky Department for Health University of Kentucky Medical Library

ME Maine CDC Maine Medical Center Library MA Boston Public Health Commission* University of Massachusetts Soutter

Library MA Massachusetts Public Health Department Lemuel Shattuck Hospital Library

MD Maryland Dept of Health & Mental Hygiene University of Maryland HS Library

NH New Hampshire DHHS New Hampshire DHHS Library

RI Rhode Island Department of Health (RIDH) Rhode Island Hospital/Lifespan

VT Vermont Department of Health (VDH) UVM Dana Medical Library

WI Wisconsin Department of Health Services Ebling Library of the Health Sciences

Enterprise Licensing Efficiencies(The 10% Rule)

Factors Influencing Rule (Collective Data)

Number Attending Training Number Responding to Journal

Survey Monkey Identification of Divisions and

Program Areas Utilizing Information (T=10, 124)

10 % of Total =1,012

State PHD FTE Early Users % Users

ADH *695 69 10%

AKDPH 525 55 10%

BPHC* *650 65 10%

CDPHE *600 60 10%

CT DPH 400 40 10%

Hawaii DPH *750 75 10%

ISDH 780 75 10%

Kentucky 400 40 10%

MDHMH *2000 200 10%

Maine CDC 395 40 10%

MDPH *1500 150 10%

NH DHHS 279 30 10%

RIDH 400 40 10%

VDH 350 35 10%

WDPHS 400 40 10%

Digital Library Resources: Databases

NLM Databases: PubMed, Toxnet + ASABE NAL’s Information Centers (Water Quality/Food Safety) CDC’s New Repository Cochrane Systematic Reviews STAT!Ref (40 e-book titles) Global Health (Cabi) CLSI (Clinical Standards Database)-New in 2013 ASABE Online Technical Library

Digital Library Resources:Full-Text Access to Journal Articles

Single Titles (14) – Societies +

Health Affairs American Journal of Tropical Medicine &

Hygiene Journal of Agricultural Safety Journal of Exposure Science &

Environmental Epidemiology Journal of Food Protection Journal of Public Health Policy Journal of Studies on Alcohol & Drugs Journal of Wildlife Diseases International Journal of Tuberculosis New England Journal of Medicine Pediatrics (American Academy of Pediatrics) Public Health Reports Scandinavian Journal of Work,

Government Produced Journals (5) Emerging Infectious Disease Environmental Health Perspectives Journal of Agricultural Health & Safety Morbidity & Mortality Weekly Report (MMWR) Preventing Chronic Disease

E-Journal Packages (110)

Annual Reviews (9) American Society of Nursing (3) BJM Journals (6) Oxford University Press (20)

Ovid --Wolters Kluwer (2) Mary Ann Liebert (12) Maney Publishing (3) Ovid (LWW) Titles (6) Sage (11) Springer (18) + 4 University of Chicago Press (6) American Society of Microbiology (12)

National Resources Related to Evidence-Based Resources

NLM’s PubMed, PubMed Central, Toxnet +

NAL’s Information Centers Food and Nutrition Information Center (FNIC) Food Safety Information Center (FSIC) National Invasive Species Information Center (NISIC) Water Quality Information Center (WQIC)

CDC Resources Related to Literature Review Community Guide to Preventive Services CDC Journals: MMWR, EID, PCD (alpha inclusion in journal list) Science Clips CDC Stacks Data & Statistics by Topic (NCHS; FastStats; Interview Surveys)

Rapid access to a comprehensive array of peer-reviewed articles.

Direct access to full text without going through a library. Access to electronic textbooks and reference books. Best-practices guidelines from all states. Recorded lectures from medical schools, schools of public

health, etc. Ways to save ongoing searches. Access to an image library. Access to cited references. Catalog of model public health laws.

Baseline Collection of DataIntroductory Meeting

Journal Survey Monkey Results

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Clinica

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PPT

Pres

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Prog

ram

Dev

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t

Confe

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eria

ls

Prog

ram

Eva

luat

ion

Polic

y Dev

elop

men

t/Pol

icy B

riefs

Spee

ches

or T

alking

Poi

nts

Grant

App

licat

ions

Legi

slativ

e Rep

orts

Pres

s Rel

ease

s/Med

ia

Budge

t Doc

umen

ts

Other

0200400600800

10001200 1119

643

851 819718 698

393

577 539455

380

564

227151

Information Need Related to Work Task

HI, AK, HI, IN, MA, MD=1514

Digital Library Pages

Connecticut Department of Public Health Arkansas Department of Health

Digital Library Pages

Alaska Division of Public Health

Hawaii State Department of Health

Functionality --Search web for full-text–

symbol: paperclip --Create Groups, e.g., just vaccines --Ability to Search multiple

databases, e.g., and e-books --Cite While you Write Feature With

Word --Drag/Drop article into record --Input records manually or

electronically --Records can be ordered by clicking

on the field, e.g., year

18 copies provided as incentive to improve skills; save time; comply with national competency objectives.

EVALUATION PROCESSES

Journal SurveyMonkey (baseline data) Enterprise Licensing (cost effectiveness over time) Vendor statistical reports validate “use of

resources” Monthly reports from “library partners” to measure

use and identify resources to add to Digital Library Page

Ongoing capture of suggested e-books, journals, and databases to enhance collection

Results from Pre-Post training links Feedback from hands-on training Interviews with leaders and workforce Focus group sessions Quarterly/Annual Reports (submitted to NLM)

Progress to Date

Use of Resources & Cost EfficienciesNew Resources & Preliminary DataTraining: Content & SummaryLessons Learned & OutcomesEnterprise Cost Efficiencies

NEJM Comparative Use:Contract Year/ Current Year

Public Health Department

May 2011-Apr 2012

Jan 2013-July 2013

VDH 1179 792

Maine CDC 715 406

BPHC 371 337

NH DHHS 553 316

CDPHE 754 223

MPHD 7078 3112

RIDH 731 415

CT PHD 1713 1603

KY DPH 79 665

ADH 0 239

WI DHS 0 954

ISDH 0 178Maryland DHMH 0 520

HI DPH 0 63

AK DPHS 0 0Total 13173 9823

0

2000

4000

6000

8000

10000

12000

NEJM Use by 15 PHDs

Jan-Jul 2013; N=9823

May 2011-Apr 2012; N=13,173

Oxford University Press UseJuly 2012-June 2013; N=9944

PHDs TotalMDPH 1830CT DPH 1256KY DPH 1066ADH 1006MDHMH 741Maine CDC 736VDH 660WI DPH 656RIDH 572AK DPH 514CDPHE 486NH DHHS 184BPHC 178HI DPH 59

Journal Title TotalClinical Infectious Diseases 1412American Journal of Epidemiology 513Schizophrenia Bulletin 393JNCI: Journal of the National Cancer Institute 343ICES Journal of Marine Science 269The Journal of Infectious Diseases 259International Journal of Epidemiology 184Journal of Antimicrobial Chemotherapy 156Nephrology Dialysis Transplantation 151Journal of Analytical Toxicology 128Annals of Oncology 100Toxicological Sciences 98Journal of Pediatric Psychology 95

Total Use by Each PHD High Use 13 OUP Titles

Journal Titles Added in May 2013

Use of Journals added in May, 2013

Represents 8 different publishers

Journals contain topical interest of public health workforce

Title #UsesBMJ 1031

American Journal of Clinical Nutrition

450

Tobacco Control 285

Journal of Antimicrobial Chemotherapy

200

Diabetes Educator 93

Annual Review of Public HealthArchives

87

The Journal of School Nursing 83

Health Promotion practice 83

Journal of General Internal Medicine

75

Archives of Environmental Contamination and Toxicology

36

CLS

I Sta

nd

ard

s

New

Data

base in

May 2

013

22

Docu

men

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ep

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632

Training Begins with Defining Type of Evidence and Relationship to Practice

Formulated literature searches Evidence-based guidelines Systematic reviews Review of best practices Public Health data/resources

Training component : Development of a well-defined, clearly-focused question

Total of 7.0 Hours TrainingTwo Days: Back to Back

Training Topics – Day 1 Training Topics – Day 2

Welcome & OverviewPublic Health

Leadership Project Introduction Why Evidence-Based Public

Health* NLM’s PubMed Database Introduction to EndNote 7 Practicum Computer Lab

Assignment

Review of Digital Library Page**

Introduction to Cochrane Library & Systematic Reviews

Alternative Article Delivery Service

Introduction to Global Health Introduction to STAT!Ref Review of EndNote 7 Brief Info about NIH

RePORTER Practicum Computer Lab

Assignment

Number of Trainings/Diversity of Workforce

STATE PHD Trainings

Attendance

RI RIDH 2 30

VT VDH 3 46

MEMAINE CDC* 3

52

MA BPHC* 4 58

MA MPHD* 3 32

NHNH DHHS 2

24

CO CDPHE* 5 100

CT CT DPH* 5 101

KY KDPH 2 46

AR ADH 2 31

WI WI DPH 2 33

AK AK DPH 2 50

HI HI DPH 2 68

IN ISDH 2 60

MD MDHMH 2 38

TOTAL 15 41 769

Maryland Indiana Hawaii

Nutrition Specialist (2)

State Epidemiologist

Education Coordinator (2)

Research Statistician

Supervisor – Labs + (3)

Asthma Coordinators(2

Policy Analyst (2)

Injury Prev Epidemiologist

Legislative Liaison

Program Mgr (2)

Staff Attorney Epidemiologist

Epidemiologist Microbiologist ( 2) Research Analyst (2)

Medicare Specialist/Advisor (2)

Regional Program Director

Program Coordinator, SAPB

Policy Advisor (2)

Director of Prog Evaluation

Epidemiologist (3)

Psychiatric VT Director of Prog Development

Genetic Counselor

Executive Ass’t Field Epi Director Tobacco Prevent Mgr

DeputySecretary

Access Services Mgr

Informatics Analyst

Director VSA IT Supervisor Nutritionist

Enterprise Licensing Efficiencies: Single Titles

Contract Year May 2012-April 2013Journal Title # Uses Cost

Per UseReplacement Cost

Cost of License

Am J Tropical Med & Hygiene 410 $1.58 $4,510 $ 650

Am J Respiratory & Critical Care Med

189 $14.28 $2,079 $2700

Health Affairs 2038 1.81 $22,418 $3690

Infection Control & Hospital Epidemiology

638

Public Health Reports 658 4.69 $7,238 $3085

Intern’l J of Tuberculosis & Lung Diseases

192 5.83 $2112 $1120

Annual Review Series 595 12.60 $6545 $7500

Pediatrics 7846 .68 $86,306 $5300

Article Delivery Costs Via Library Partnerships

May 2011 – April 2012; Cost=$18,384 May 2012 --- April 2013; Cost=$12,241

STATE ILL DD Total

Connecticut 0 83 83

Maine 560 364 924

Massachusetts (BPHC) 8 3 11

Massachusetts (MDPH) 1 1 2

New Hampshire 0 0 0

Rhode Island 47 36 83

Vermont 21 191 212

Colorado 323 156 479

Total 960 834 1794

STATE ILL DD  Total

Connecticut 2 20 22

Maine 154 90 244

Massachusetts (BPHC) 9 10 19

Massachusetts (MDPH) 7 6 13

New Hampshire 0 0 0

Rhode Island 82 79 161

Vermont 54 243 297

Colorado 112 40 152

Arkansas 32 73 105

Kentucky 8 3 11

Wisconsin 0 0 0

Total 462 593 1055

Cost E

fficie

ncie

s:

Artic

le A

naly

sis

Dire

ct Acce

ss to A

rticles

Alte

rnativ

e A

rticle D

eliv

ery

Contract Year Total # Amount

May 2012-Apr 2013 1055 12,241

May 2011-Apr 2012 1794 18,385

May 2010-Apr 2011 672 8,263

Contract Year Total # Amount

May 2012-Apr 2013 15 200,352

May 2011-Apr 2012 11 156,280

May 2010-Apr 2011 9 96,252

Lessons Learned

Better Understanding of the Culture› Relationships – of workforce: variance in skills and

knowledge, variance in topical › Uneven access to information

Institutional Change› Dissemination plan› IT Differences

Transparency of Access Nurtures Practice and Career Pathways Cost Efficiencies

Advancing the Project(Where do we go from here?)

Work with the “Built Environment” to provide a sustainable model for all Public Health Departments.

Continue to Promote Project Efficiencies Dissemination Plan (natural turnover of

personnel; retraining) Gather data to justify access for “Local

Public Health.”