EBL’s research interests include integrating evidence into the patient care and research workflow using informatics applications; assessing various stakeholder groups' interaction with health information; education, skills development, and leadership development of librarians; optimal selection and use of information resources; organizational knowledge management; and digital library development.
The EBL was awarded an Institute of Museum and Library Services National Leadership Planning Grant in October 2008 to develop strategies for assessing children’s interactions with health information. The team of librarians, psychologists, child development experts, pediatricians, informaticians, evaluators, and educators employed the planning period to develop techniques to assess health information needs and perceptions in children.
The team formalized a number of research aspects, including which potential interventions may offer the greatest benefit for study; the appropriate age range for study; and optimal venues for testing assessments and interventions. To broaden thinking and factor in elements of generalizability and dissemination from the outset, project partners include the Meharry Medical College, Vanderbilt Children's Health Improvement and Prevention Program (VCHIP), Cumberland Pediatric Foundation, organizations that offer expertise in areas key to long-range work.
For more information about the project contact the Eskind Biomedical Library
EBL was awarded an 18-month contract from the National Library of Medicine to develop a Go Local site for Tennessee in July of 2007. Go Local aims to link MedlinePlus users to community health services and to direct Go Local users to relevant health topics on the MedlinePlus website. The Go Local Tennessee site is accessible at www.golocaltn.com.
Presentations and Publicity
For more information about the project contact the Eskind Biomedical Library.
Background
To evaluate the role of the Clinical Informatics Consult Service (CICS) in clinical decision-making, the EBL was awarded a 3-year grant from the National Library of Medicine (5 R01 LM07849). The CICS is a well-established program that facilitates evidence-based practice by delivering targeted information in answer to complex, patient-specific questions. The CICS places librarians with specialized training in medical subject areas and in information retrieval (“clinical informationists”) on clinical teams in intensive care settings. Acting as expert consultants, they analyze the biomedical literature to identify, filter, and present the best examples of each clinical viewpoint expressed about key problems.
Evaluation Project
Working in cooperation with the Center for Evaluation and Program Improvement (CEPI) at Peabody College of Vanderbilt, the investigators formally evaluated the role of CICS in clinical decision-making and evidence-seeking behavior using a randomized pre/post design. While past studies have evaluated clinical medical librarians’ roles, few if any studies have examined the effectiveness and utility of the new clinical informationist approach in sites where informationists are well-established.
Through a combination of observation and interviews, investigators examined librarian involvement in three existing Vanderbilt CICS intensive care units, collecting detailed information about the ways in which clinicians incorporate CICS-provided information into their workflows. The project also included a randomized trial to evaluate the effects of CICS on clinical decision-making. Investigators compared clinicians’ intended course of care vs. actual care when CICS results are provided and when clinicians seek information themselves.
In the randomized trial, CICS questions were randomized to receive either a full evidence synthesis as is customarily provided, or no results (in which case clinicians could look for information themselves). Requestors completed a pre-request form, detailing their intended use of the information requested (support treatment decisions, etc.) as well as a post-request evaluation form, detailing how the information (if provided) affected the patient's treatment course or whether/how they sought information themselves for the question. To ensure patient safety, clinicians had the option of overriding a "no results" randomization in cases in which they felt the CICS results were critical for patient care decisions and they had no other means of locating information. The randomized phase of the study ended in May 2006, and results of the study appeared in the March 2008 issue of the Journal of the American Medical Informatics Association (Mulvaney S, Bickman L, Giuse NB, Lambert EW, Sathe NA, and Jerome RN. A randomized effectiveness trial of a clinical informatics consult service: Impact on evidence-based decision-making and knowledge implementation. J Am Med Inform Assoc 2008; 15(2):203-211) Abstract.
The project also included the development of "virtual cases" incorporated into training tools that can be used to export elements of the CICS model to other locations. The Evidence Based Knowledge Portal incorporates cases that set tenets of EBM in the context of a clinical setting to facilitate understanding and application of techniques such as NNT and absolute risk. The tool also contains assessments to allow users to gauge their level of readiness to adopt EBM practice and an EBM tutorial. The Evidence Based Knowledge Portal is currently unavailable while the EBL makes site upgrades, but will be relaunched in September 2009.
Demonstration of the utility of the clinical informationist approach can foster widespread adoption nationally and increase the degree to which clinical practice becomes evidence-based.
Presentations and Publications
Results of the randomized trial appeared in the March 2008 issue of the Journal of the American Medical Informatics Association (Mulvaney S, Bickman L, Giuse NB, Lambert EW, Sathe NA, and Jerome RN. A randomized effectiveness trial of a clinical informatics consult service: Impact on evidence-based decision-making and knowledge implementation. J Am Med Inform Assoc 2008; 15(2):203-211) Abstract
Further information on the CICS program appears in the May 2005 issue of the Journal of the American Medical Informatics Association (Giuse NB, Koonce TY, Jerome RN, Cahall MC, Sathe NA, Williams A. Evolution of a mature clinical informationist model. J Am Med Inform Assoc 2005; 12(3):249-255. Abstract)
The project team has also presented results from a pilot study funded by the grant at the May 2004 Medical Library Association Annual Meeting; results from this pilot study were published in Academic Medicine in 2005 (Rosenbloom ST, Giuse NB, Jerome RN, Blackford JU. Providing evidence-based answers to complex clinical questions: evaluating the consistency of article selection. Acad Med. 2005 Jan;80(1):109-14.
Abstract)
The team also presented a poster outlining the preliminary development of the virtual case tool at the 2005 annual meeting of the Medical Library Association (Cahall M, Sathe NA, Todd P, Jerome RN, Giuse NB. Capturing Knowledge Management Practices of Local Expert Librarians to Inform the Development of a Virtual Case Training Tool. Presented at Medical Library Association Annual Meeting, San Antonio, TX, May 2005. (Poster)) and tool content at the 2006 Medical Library Association annual meeting. (Sathe N, Todd P, Clark J, Gregg W, Giuse NB. Virtual Cases as a Tool To Promote the Incorporation of EBM Techniques into Housestaff Training. Medical Library Association Annual Meeting, Phoenix, AZ, May 2006.)
In addition, the team has also conducted pilot studies to assess the effects of targeted communication strategies on expert information provision uptake:
Jerome RN, Giuse NB, Rosenbloom ST, Arbogast P. Customizing implementation of a novel evidence request feature in an electronic medical record system. Submitted for publication to the Journal of the Medical Library Association (JMLA). May 2007.
Jerome RN, Cahall M, Potter S, Todd P, Williams AM, Giuse NB. Scaling evidence-based services through integration with informatics tools. Medical Library Association Annual Meeting, Phoenix, AZ, May 2006 (poster).
The team has also discussed elements of the study's results regarding clinician-perceived barriers and facilitators of EBM:
Mulvaney S, Bickman L, Lambert W, Sathe N, Jerome R, Giuse NB. Barriers to and Facilitators of Evidence Based Practices in Physicians. Rapid Communications Poster presented at the Society for Behavioral Medicine 28th Annual Meeting. Washington, DC. March 21-24, 2007.
For more information about the project contact the Eskind Biomedical Library.
