Evidence-Based Practice for Public Health Project Funded by a CDC/ATPM Cooperative Agreement Lamar Soutter Library Principal Investigator: Elaine Martin, MSLS, MA Project Coordinator: Hathy Simpson, MPH Project Consultant: Roger Luckmann, MD, MPH

Overview Rationale & background of the project Project’s goals Process used to meet the goals Description of the project to date Future plans

Many EBM products have been developed for busy medical clinicians but few EBPH resources are available for public health practitioners.

A Definition of EBM The conscientious, explicit, judicious use of the current best evidence in making decisions about the care of individual patients. (Ref: Sackett et al, 1996)

Definition of EBM (cont.) EBM practice requires integrating practitioner clinical expertise with best evidence from systematic research.

A Definition of EBPH The conscientious, explicit, judicious use of the current best evidence in making decisions in routine PH practice, and in developing PH policies and programs. (Ref: Sackett et al, 1996)

Definition of EBPH (cont.) EBPH practice requires integrating practitioner expertise, accumulated PH and basic science knowledge, and regulatory requirements, with best evidence from systematic research.

Spectrum of Evidence 1.Definitive clinical and epidemiologic studies of human subjects and populations 2.Consensus of experts based on historical observation and experience in human populations 3.Findings from basic science research extrapolated to humans

Spectrum of Evidence: Clinical and Epidemiologic Studies 1.Systematic reviews of multiple valid intervention studies 2.One or more randomized controlled trials or other intervention studies 3.Systematic reviews of multiple valid observational studies or evaluations 4.One or more observational studies or evaluations

Rationale for Evidence-Based Practice for Public Health Project Increasing amount of high quality, relevant research in PH and in disciplines related to PH (medical, behavioral, social sciences). Great need for high quality, evidence- based information by PH practitioners. Access to best evidence limited

Evidence-Based Practice for PH: Key Questions What are the knowledge domains of PH? What is / Where is the relevant “evidence” for each domain? What are the needs of PH practitioners for current “evidence” in their fields? How can access to required current evidence be improved? What model/s for information delivery can best meet PH information needs?

Evidence-Based Practice for PH: Methods. Define the knowledge domains of public health Identify and assess existing sources of EBPH content and existing means of delivering it Examine, classify, evaluate existing models for synthesizing and delivering EBM content to medical practitioners

Evidence-Based Practice for PH: Methods Identify characteristics of EBM synthesis/delivery methods potentially relevant to models for delivery of EBPH content. Propose model/s for synthesis/delivery of current EBPH content for selected knowledge domains and related practitioner groups.

Identifying the Knowledge Domains of Public Health The field of public health is very broad and diverse Activities range from disease control to health care financing

Identifying the Knowledge Domains of Public Health There are multiple disciplines (knowledge domains) within the field of public health

Public Health is Multidisciplinary Epidemiologists Statisticians Environmental Engineers Animal Control Officers Sanitarians Food Scientists Industrial Hygienists Health Care Administrators Health Economists Politicians Social Workers Mental Health Workers Substance Abuse Counselors Doctors Nurses Teachers Disaster Relief Workers Nutritionists Lab Technicians

What are the Knowledge Domains of Public Health?

Process Used to Identify the Knowledge Domains of Public Health Examined public health sources What “knowledge domains” or areas of public health do these sources include?

Public Health Sources Used to Identify the Knowledge Domains of Public Health 1.Public health accreditation criteria 2.Chapters from an academic public health reference book 3.Collection categories of the American Journal of Public Health 4.Public health occupational categories 5.Massachusetts Department of Public Health 6.American Public Health Association (APHA)

Public Health Sources Used to Identify the Knowledge Domains of Public Health 7.Healthy People 2010 national health objectives 8.Public health guidelines from The Guide to Community Preventive Services 9.Ten essential services of public health from the Public Health Functions Working Group 10.Library indexes: NLM journal subject headings & MeSH; public health subject headings from the Library of Congress

Example of a Public Health Knowledge Domain: Environmental Health

We Identified 17 (with their subdomains) Public Health Knowledge Domains Epidemiology (6) Biostatistics (6) Vital Statistics & Surveillance (7) Environmental Health (13) Occupational Health (3) Health Services Administration (15) Social & Behavioral Sciences (8) Health Promotion & Education (4) Community Health (18) (includes Maternal & Child Health) Public Health Nursing (3) Disaster Control & Emergency Services (4) Communicable Diseases (16) HIV/AIDS (4) Chronic & Noncommunicable Diseases & Conditions (18) Public Health Laboratory Sciences (5) Public Health Informatics (5) Global, International Health

The Next Step in the Process: What is the literature associated with the identified knowledge domains of public health? –Identify public health journals

Process Used to Identify Public Health Journals Used ISI’s Journal Citation Reports to identify top public health journals by impact factor Created a list of public health journals using three sources: 1.CDC Information Center: list of the most frequently requested journals 2.Healthy People 2010 Information Access Project: list of the most frequently cited journals from formulated search strategies 3.Journals identified through the MLA’s Core Public Health Journal Project

Public Health Journals Identified 1.List of the top 25 journals by impact factor in the subject category: “Public, Environmental, and Occupational Health” 2.List of 698 public health journals –Available online? –Free or by subscription only? –If free: Internet link (URL)?

The Next Step What public health literature is associated for the identified knowledge domains of public health? –Match journal titles with knowledge domains

Example of a Public Health Knowledge Domain: Maternal and Child Health

Public Health Knowledge Domain: Maternal and Child Health Some associated journals: –Maternal and Child Health Journal –American Journal of Obstetrics and Gynecology –Paediatric and Perinatal Epidemiology –Archives of Disease in Childhood –Archives of Pediatrics and Adolescent Medicine –Child Abuse and Neglect –Child: Care, Health and Development –The Future of Children –Journal of Child and Family Studies –Pediatrics International

Accomplishments To Date Identified the knowledge domains of public health Identified public health journals Created project website In progress: Match identified knowledge domains with public health journals

The Project’s Website

Future Goals for the Next Year Determine the information needs of public health workers vs. clinical workers. Identify the characteristics of clinical EBM products. Can any of the characteristics be applied to a model for evidence-based public health? What is our definition of evidence- based public health?

Future Goals for the Next Year Continued Would public health workers use the product? What features would public health workers want? Choose sample public health knowledge domains to test evidence-based model(s) for public health practice.

Evidence-Based Practice for Public Health Project Personnel Principal Investigator: Elaine Martin, MSLS, MA Project Coordinator: Hathy Simpson, MPH Project Consultant: Roger Luckmann, MD, MPH Project Consultant: Sharon Telleen, PhD Technical Advisor: Jocelyn Rankin, PhD