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National Medical Librarians Month

Middle Atlantic Region Featured Projects 2011

Value of Library and Information Services in Patient Care Study

The Value of Library and Information Services in Patient Care Study http://nnlm.gov/mar/about/value .html (hereafter referred to as the Value Study) is a research project designed to understand the value of the health library, information services, and the librarian in patient care. The study employs mixed methods to investigate 1) the use and value of the print and electronic resources provided by the library and 2) the information services (mediated or assisted information requests/searches) provided by the librarian that aid in clinical decision-making. The Value Study has been funded by in part with federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3501 from the New York University Middle Atlantic Regional Medical Library Program. Additional support is provided by the Hospital Library Section of the Medical Library Association (MLA), the NY/NJ Chapter of MLA; the Philadelphia Chapter of MLA; the Upstate New York and Ontario Chapter of MLA; the New York State Reference and Research Library Resources Councils and the Donald Lindberg Research Fellowship from MLA.

The study builds on previous research, notably that of the Rochester study (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC225641/) conducted in the Rochester, NY, area in the early 1990s. The current study updates the Rochester study and recognizes the changed environment in which librarians and library users and non-users seek and find information to make clinical decisions.

The Value Study employed a multi-stage research design with a pilot phase involving 7 libraries and a full phase involving 49 libraries. The University of North Carolina at Chapel Hill (UNC) was awarded a contract to conduct:

  • A survey of physicians, residents and nurses affiliated with participating libraries to assess the value of the library and information services in patient care.
  • Interviews with selected physicians, residents and nurses from participating sites to understand the role of the library resources and the librarian in providing information related to patient care.

The study included a web-based survey of physicians, residents, and nurses. The survey explored the information services used by patient care providers and the impact of the health information on patient care. Similar to the Rochester study, the survey employed a critical incidence approach, whereby respondents were asked to recall a recent occasion an occasion in the last six months when they looked for information resources for patient care (beyond what is available in the patient record, EMR system, or lab results) and to answer questions regarding this occasion.

A pilot study was conducted to ascertain the effectiveness of study design, survey content, structure, and delivery method. The pilot test was conducted in the NN/LM Middle Atlantic Region.  Seven health libraries participated in the pilot test. Participating librarians were responsible for publicizing the survey to their physicians, residents, and nurses. The research team provided the librarians with templates of survey communication: publicity flyer, survey notification, invitation, and three reminders. The web survey was available from September 13, 2010 to November 19, 2010. The survey had 3,217 responses.

The second phase of the pilot test involved qualitative interviews with physicians, residents, and nurses. The goals of the interview were to understand the search behaviors of health professionals, the impact of self-guided searches on patient care, and the value of the librarian in searching and the value of health information (no matter where obtained) in patient care. The research team has conducted 23 interviews from the 201 respondents that were willing to be interviewed.  The research team has transcribed the interviews and uploaded them into an NVivo database for analysis.

For the full study, minor modifications were made to the methodology. The team invited health libraries in U.S. and Canada to participate in order to strengthen the study findings. The study enrolled 108 libraries in the study. Fifty-nine libraries dropped out of the study due mostly to timing and staffing issues. Forty-nine libraries participated in the full study. As in the pilot phase, the participating libraries were asked to complete a brief questionnaire to capture organizational characteristics. Survey Science Group was contracted to administer the web-based survey of physicians, residents, and nurses, both in the pilot phase and full study. Participating librarians were responsible for publicizing the web-based survey to their patient care providers. The research team provided a communication packet for the libraries. The full launch survey was available from March 17, 2011 to May 2, 2011. Over 15,000 providers responded to the survey. The UNC research team has just received the final data set and plans to complete the remaining tasks using the funds from the Donald Lindberg Research Fellowship from the Medical Library Association.

Project Director:  Joanne Gard Marshall
Institution:  University of North Carolina, Chapel Hill

Evaluating MedlinePlus Connect-The Institute for Family Health

The Institute for Family Health (http://www.institute2000.org/), a community health center in New York City, collaborated with its project team between July 2010 and April 2011 to develop and pilot test strategies for evaluating MedlinePlus Connect, the National Library of Medicine resource that links patient-specific health information with the patient portal of an electronic health record (EHR) system to relevant consumer health information on MedlinePlus.  MedlinePlus Connect is currently implemented within the Institute's own patient portal, MyChart-MyHealth.

The project team, which included members from the Instititute, Columbia University, Weill Medical College of Cornell University, and the University of Miami School of Medicine, worked over the course of the NN/LM MAR award contract to achieve the following:

  1. further develop MedlinePlus Connect by creating direct links from medication sections of MyChart-MyHealth to relevant information on MedlinePlus
  2. develop reporting capabilities that will enable comparison of characteristics between MyChart-MyHealth users who do and do not use MedlinePlus Connect
  3. develop a formative pilot study to assess the usability and utility of MedlinePlus Connect to MyChart-MyHealth users

All three objectives were achieved.  Work on the first objective was completed in Fall 2010 and is now implemented in MyChart-MyHealth.  The Institute expanded on this effort by creating additional links from its newly launched Spanish-language MiRecord-MiSalud to Spanish-language information in MedlinePlus. The Institute also provided EHR-based laboratory test data to MedlinePlus staff to facilitate linkage to relevant content in MedlinePlus, and it is working to develop links to allergy and immunization information documented in the patient portal.

The Institute worked with NLM and its EHR vendor Epic to develop a program within MyChart-MyHealth (and its Spanish version) to track use of MedlinePlus Connect.  Patient use of MedlinePlus Connect from MyChart-MyHealth was tracked from 2/21/11 to 4/27/11.   During this period, over 900 Institute patients clicked on links to a wide variety of health topics and nearly 800 separate web pages, with an average of 24 patients per day linking to an average of 1.75 topics.  De-identified tracking data reports were developed to conduct a preliminary analysis of MedlinePlus Connect use by patient characteristics.  A minority (8.9%) of the Institute patients with MyChart-MyHealth accounts used the links during the tracking period.

To better assess patient awareness of MedlinePlus Connect, questions were added to an existing patient telephone interview protocol. This survey is ongoing, but preliminary data from 22 interviews with patients with MyChart-MyHealth accounts found that 18 (82%) of them were not aware of the MedlinePlus Connect links within the portal. These early data suggest that the Institute must develop a strategy to raise patient awareness of MedlinePlus Connect.

The project team developed a usability testing protocol for MedlinePlus Connect that includes a recruitment script, a participant consent form and background questionnaire, and a facilitator guide. The team was unable to recruit eight participants to pilot test the protocol, but it is developing strategies for more effective recruitment.

Overall, this project has led to the development of a series of strategies for assessing the use and usefulness of MedlinePlus Connect among community health center patients.  This work has laid the foundation for a longer term and more comprehensive assessment of MedlinePlus Connect.

Project Director: Diane Hauser
Institution:  The Institute for Family Health

Health Literacy Curriculum: Tools and Strategies for Improving Health Communication

The primary purpose of this project was to develop a curriculum for health professionals and providers with practical solutions for improving health communications in their own practice settings.  The project continues the collaboration initiated by the Public Health Information Partners Project, expands the health literacy efforts at New York Medical College and in the Hudson Valley region, and work with participants from a 2007 health literacy conference.

A cohort of trainees was planned with each trainee expected to train others, use or share applications, and participate in a moderated health literacy wiki or blog.  A total of 200 participants was targeted, including: health professionals, providers of direct patient care, community leaders and librarians working in health care settings.  Leaders included professional employees in public health departments, nurses, health/medical faculty and educators, and medical libraries from the NN/LM MAR.

The project's four objectives were as follows:

  1. Complete a preliminary needs assessment of professionals in the Hudson Valley region.
  2. Implement a "train the trainer" model for participating health professionals.
  3. Create a regional health literacy wiki or blog to foster effective communications and networking among health professionals with an interest in health literacy.
  4. Evaluate the use of specific strategies and tools in clinical or professional practice.

The needs assessment confirmed that there was a high level of interest in health literacy programming, and that a focus on practical strategies was desired.  Subsequent research informed the development of a training curriculum. By April 30, 2011,  three training events were scheduled using reputed health communication and health literacy experts.  The program descriptions, handouts, and photos are available at this website: http://library.nymc.edu/PHInformatics/index.cfm.   A total of 276 participants attended one or more events.

The health literacy wiki http://hlit.libmedia.nymc.edu/index.php/Main_Page) was created next.  By June 15, 2011, a total of 29 users were registered, with 296 users of the toolkit.

Evaluation of the project continues, but results show that we have successfully created a cohort of health professionals interested in honing their communication skills with patients/consumers and have provided them with the practical tools and strategies that they value and wish to continue to enhance.

Project Director: Dianna Cunningham
Institution: New York Medical College Health Sciences Library

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