AcademyHealth Roundtable:How to Publish Without PerishingMEET THE EDITORS:• Ann Flood Health Services Research• Par Atwal Health Affairs• Brad Gray Milbank Quarterly• Gloria Bazzoli Med Care Research & Review• Catarina Kiefe Medical Care• Alan Monheit Inquiry• Arnie Epstein* New Eng J Medicine

Outline for today

• Brief intro about typical peer review process and likelihood of acceptance [AF: HSR]

• Roundtable reply to two Q’s [5 min. ea/Q]– Hints for success at their journal– Unique ‘feature’ at their journal

• Q&A from the audience

Making Peer-Reviewed PublicationMore User-Friendly

Peer review is friendly? But what about:

* All those rejections?

* Exposing your work to anonymous reviewers?

* Perishing unless you publish?

Some Publish and Perish!Peer review in the 1500s

• Servetus, Spanish physician 1509-1553– Published theory: blood flowed from right to

left of the heart through the lungs [etc.]– Burned at the stake by John Calvin

• Galileo– Published a book, Dialogue on Two Chief

World Systems– Confined to his home; forced to retract support

of Copernicus’ theories

A Overview of the Process: Using HSR as an example

• Often appears to be a “black box”

• Occasionally more like a “black hole”

• Understanding the steps can reduce anxiety

• AND provide hints for more success

Preparation of the Manuscript (MS)

• Choosing a journal…– Look where ‘similar’ ms have been

published

– Review journals to determine what they publish

• Look through issues

• Mission Statement

• Audience

• Instructions to Authors

Preparing Your Manuscript (MS)

• After you choose a journal… – Follow their guidelines re styles,

length, etc.– Consider options for review-only

appendices– Collect any additional material,

e.g., related papers that might be considered duplicative so want to show they aren’t

Submitting the MS• NO paper!

• Go to our website http://hsr.manuscriptcentral.com

• Fill out information as an author and potential reviewer

• Submit electronic version of MS (Word, WordPerfect, PPT, etc.)

• Use Endnote [checks Web of Science]

• Review the PDF version created

• Get an acknowledgement

What We Do First

• Assign the MS to an EIC– Selection is based

largely on workload, potential conflicts of interest, and related manuscripts

• The EIC then determines whether the MS goes out for review

470 new ms./yr*

280 external rev/yr*

* 2008 projected regular issue submissions

The First Barrier: The Editors• “No Reviews” mostly reflect

– “Lack of fit” with the journal– Very narrow potential audience– Not likely to be a contribution

• 2007 at HSR: – ~ 42%* of new submissions were

assigned to “No External Review”– Mean time to decision—7.8 days

• The “surviving” MSs are assigned to a Senior Associate Editor (SAE)

* estimated, includes EIC-SAE decisions

Examples of ‘fit’ for HSR

• Audience• Broad-based

multidisciplinary researchers, methodologists and policy wonks

• Mostly US based but with a global context

• MissionTo further our vision andvalues by publishingthoughtful, timely, rigorouslyconducted, state-of-the-artresearch on healthcarethat is widely disseminatedand meets the higheststandards of scientific peerreview.

Identifying Reviewers• Identify >2 reviewers, who as a

set have the needed expertise• Identifying willing and

appropriate reviewers is difficult• Authors can help by suggesting

many potential reviewers (with e-mail addresses)

• This can shorten the time to get a decision

• CAN suggest who not to use

What is a good review?

• Cites strengths and weaknesses• Detail that supports recommended decision• Separates major and minor points• Informs editors about issues such as:

– potential conflicts or biases [not always ‘bad’]– inside information– previous reviews of ‘same’ manuscript– suspected plagiarism – similar works by same authors– lack of expertise for evaluating some parts

What is a bad review?

• Personal comments• Mean comments• Irrelevant comments• No detailed support for judgments• Not disclose conflict of interests• Touts own work that wasn’t referenced• Tells authors what their decision is

Waiting for a Decision

• Perhaps the most difficult part for the author

• Manuscript Central (MC) lets you know the current status

• MC automatically reminds reviewers about late reviews

• The EICs have much more information about where things stand and whom to nudge

Reaching a Decision: Both Reviews are ‘In’

• Reviewers’ comments to authors and editors go to the SAE

• SAE re-examines the full record [paper and reviews] and recommends a decision & comments for authors

• The EIC who started the process then makes the final call

• SAE and EIC need to agree• EIC sends letter to the author w

decision, special advice from us and reviews

• & sends thank-you letter w decision and reviews to reviewers

The Initial Decisions Were: [for MSs sent out for initial external review

and with a decision]

• OVERALL TIMING:– In 2002: 126 days to 1st decision#

– In 2007: 81 days!• OUTCOMES, if reviewed*

– Accept 1.6% (only if invited)– Reject 59.5%– Revise and resubmit 38.8%

Major revision 32.9%Minor Revision 5.9%

• * Based on 438 newly submitted regular ms only, 2006• #Includes decisions to revise, reject or accept

Major Revise and Resubmit• Reviewers are sometimes quite

negative about a paper as written• But they, or the editors, see

significant potential, e.g., a unique data set that was not well used

• However, it is not clear that even if authors can redo the analyses, or if the (yet unknown) results will be interesting enough to publish

• Our letter explains the risks involved

Back to the Authors

• Reviewers’ comments are sometimes conflicting– The editors try to resolve the

more extreme conflicts• More information is usually

requested by reviewers• The paper is almost always too

long and needs to be cut• Some authors decline to resubmit

[this is rare]

Revisions and Responses• Slavish revisions may not be

appropriate (but reviewers will see)

• It’s your paper and we may have “gotten it wrong”

• But, if we did, our readers might also be “confused”

• Detailed memos explaining how you addressed each point are very helpful

• Electronic appendices allow space for more detail

• Don’t take too long! [the biggest consumption of time is by authors]

Improving Your Ms: Typical Problems

• Important flaws– Over conclude, over-sell implications

– Not original contribution

– Analyses have problems

– Poor write up of tables, methods, results

• Minor problems– Not using HSR style

– Too long

– Lots of grammatical mistakes

The Next Cycle

• Revisions go to SAE• Sometimes an

immediate decision• Usually back to the

reviewers– Especially if major

revisions• Then back to SAE

and EIC

Decision on First Revisions

• In 2005, at end of 2nd cycle• Accepts/Conditional 46%• Reject 6%• Revise (minor/major) 43%

– [up to 3 revisions ]

• Pending 5%

After Acceptance, You’re Not Done Yet

• The MS then goes to Wiley-Blackwell, our publisher, for copyediting

• Author needs to review, respond to questions, and approve, with a very short turnaround

Published Online & in Print

• For accepted papers…– Paperless process to publisher too

• Exception: original signatures on copyright & discl!

– Online Early Publishing (~2.5 months in 2007)• When copyediting done, published online• Fully citable, available to subscribers on web• Referenced in MedLine

– Appears in print next avail issue (~ 8 months in 2007)

And now…hear from other editors1. What criteria should authors use to choose and prepare their ms for your journal?

What IS your mission?Who IS your audience?

What hints would you give authors regarding meeting or exceeding your ‘quality bar’?

How important is using the right style for your journal?

And now…hear from other editors2. What feature[s] is most 'unique ' to your

journal?

How can authors successfully orient their ms to this feature?

Any special process for this feature… such as should they ask before submitting? Send an abstract? Else?

Help in producing ‘good science’

Teach good reviewing/aid authors• HSR publishes and adds to HSR.org webpage:

– Example of MS and reviews and authors’ response– Editorials about peer review process– Section on “Building the Field” such as…

• Poster presentation vs podium presentation hints• Multidisciplinary usages in the field• Training future researchers

Help in producing ‘good science’

• Monitor prior dissemination• HSR requires authors to disclose all & may not publish if

– not original [never]– published, accepted, or submitted for publication elsewhere [never]– previously distributed publicly via the Internet or via national meetings

[usually okay, subject to the approval of the Editors]– Major website or report with wide distribution to our audience [maybe]

– Our bottom line: Prior dissemination of findings does not automatically preclude review and acceptance of an article, but raises the bar with respect to how publication in HSR will benefit the field.

Help in producing ‘good science’

• Monitor $ & conflict of interest• HSR require authors to disclose all & may publish some:• Financial support

– all financial and material support (including the provision of, or access to, data) for the research

• Financial and policy conflicts of interest– all affiliations and financial involvements with organizations with a

financial or policy interest in the subject matter in the manuscript

• Advocacy– public stands they have taken (in print, media, testimony, or other venues)

that are identified with a particular advocacy position that’s relevant to ms– whether their current (or at the time of writing) organization is identified

with such an advocacy position.

Help in producing ‘good science’

Other roles such as….– Monitoring duplication/splitting hairs– Monitoring human subject protection– Access of public to the science in journals– And continuing to improve our journals

• Adding features that take advantage of new technology• Newest features at HSR

– Theme Issue [an extra ‘Regular Issue’ on important theme]– Call for Papers by August 21 2007 on:

• Improving Efficiency and Value in Health Care– see www.HSR.org for call or give me your card