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Lamar Soutter Library Director Elaine Martin and Consultant Karen Dahlen introduce a digital public health library initiative that supports national and state public health departments. Success stories and next steps to build a sustainable digital library model for all public health department is covered.
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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
Educ
atio
n
Jour
nal A
rticle
s
Clinica
l Gui
delin
es a
nd P
roto
cols
PPT
Pres
enta
tions
Prog
ram
Dev
elop
men
t
Confe
renc
e Mat
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
ts S
ep
t 2
01
3N
=2
3To
tal U
se=
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.”