Models of Information Summary, Synthesis, and Dissemination In Clinical Medicine Sources and Organization of Evidence-based Knowledge Principal Investigator: Elaine Martin, MSLS, MA Project Coordinator: Hathy Simpson, MPH Project Consultant: Roger Luckmann, MD, MPH

Evolution of Medical Models of Information Dissemination Information explosion Increasing expectations of EBM practice Studies documenting information needs The Internet and advances in computer hardware

Evolution of Medical Models of Information Dissemination Improving computer searching strategies and results displays Development of methodology for EBM critiques and systematic reviews Market forces driving rapid development of many new online resources: full text books and journals, collections of databases, new original online content creatively organized

Information Needs and Resources in Medicine and Public Health Need for answers to problem-specific questions arising frequently in daily practice, not answered by common knowledge/guideline. –Med: Most common need usually related to individual patients –PH: May be much less common need, more often related to a population, sometimes to individual clients

Information Needs and Resources in Medicine and Public Health Need for best information to develop/revise policies, programs, and guidelines. –Med: Common need only for select group of practitioners –PH: May be most common need

Information Needs and Resources in Medicine and Public Health Type of information needed –Med: Very large databases of interventional studies, observational studies, guidelines, accumulated clinical and basic science knowledge relevant to both routine questions and policy/guideline development –PH: Many fewer community interventional studies, similar needs for observational studies and guidelines, also evaluation studies, accumulated public health knowledge, epidemiologic data, policies and procedures

Models of Summary, Synthesis and Dissemination of Clinical Medical Evidence 1.Reports of Original Research 2.Summaries, Critiques and Commentaries on Individual Original Research Studies (and sometimes systematic reviews and meta- analyses) 3.Systematic Reviews and Meta-analyses (focus on a topic and often provide a guideline for practice) 4.Comprehensive Knowledge Bases

Reports of Original Research Formats: Hardcopy of journals Online journals Collections of online journals Databases of study titles, abstracts, and references (Medline, other relevant databases)

Reports of Original Research Quality: Varies widely Editors and reviewers responsible Quality filters for assisting in searching databases Updating: Regular and frequent related to schedules of journal publication

Reports of Original Research Pushing Regular s of titles and abstracts Selected topics Wide range of delivery services Single journal, multiple journals

Reports of Original Research Medical Examples: Journal Websites OVID Medline PubMed Web of Science SGIM abstract delivery

Reports of Original Research Public Health Examples: MMWR and MMWR Website AJPH services SafetyLit Healthy People 2010 Information Access project (Medline Filters)

Reports of Original Research Possible Applications in Public Health: Facilitated access to collections of online public health related journals Service to push titles and abstracts of relevant articles to practitioners Filters for searching existing databases for best information Search engines to search multiple databases simultaneously

Reports of Original Research Issues: Limitations of quality filters Information overload from searches of large databases Problems in customizing content of pushed information and avoiding information overload

Summaries, Critiques and Commentaries Format: Newsletters and journals in hardcopy and online Searchable electronic databases (CD- ROM and online)

Summaries, Critiques and Commentaries Quality: Dependent on qualifications and skills of editors/commentators Related to methodology for summarization and critique

Summaries, Critiques and Commentaries Updating: Periodically as new studies come out Driven by publication of new material Lag time due to production of summaries and commentaries Pushing: Regular mailing of hardcopies

Summaries, Critiques and Commentaries Medical Examples: Journal Watch ACP Journal Club Annals of Internal Medicine Faculty of 1000 Public health examples: Journal Watch Infectious Diseases

Summaries, Critiques and Commentaries Possible Applications to Public Health Popular, accessible format for pushing filtered information with evidence-based commentary Useful format for sections of existing journals

Summaries, Critiques and Commentaries Issues: Identifying optimum style, structure, and length of summaries and commentaries Need cadre of volunteer writers with content knowledge and evidence-based critical reading skills Selection of studies relevant to knowledge domains A single study often does not answer a question

Systematic Reviews, Meta-Analyses and Evidence-Based Guidelines Formats: Collections in books and on CD-ROM Online collections

Systematic Reviews, Meta-Analyses and Evidence-Based Guidelines Quality: Dependent on methodology of review and approach to summarization Many guidelines may not qualify as “evidence-based” if not supported by a systematic review

Systematic Reviews, Meta-Analyses and Evidence-Based Guidelines Updating: Periodic without any clear systematic approach for existing collections May involve adding new topics and/or revising existing topics Pushing: Subscriptions to regular new editions

Systematic Reviews, Meta-Analyses and Evidence-Based Guidelines Medical examples: Cochrane Database of Systematic Reviews Guide to Clinical Preventive Services National Guideline Clearinghouse

Systematic Reviews, Meta-Analyses and Evidence-Based Guidelines Public health examples: Guide to Community Preventive Services Cochrane Public Health topic reviews CDC Prevention Guidelines System Evidence for Policy and Practice Information Centre: Health Promotion Reviews NHS Centre for Reviews and Dissemination: Economic Evaluation Database The Effective Public Health Practice Project

Guide to Community Preventive Services Topics Covered

Guide to Community Preventive Services Topics Covered

The Guide to Community Preventive Services Evaluating and making recommendations on population- based and public health interventions Reviews: Evidence on effectiveness Applicability of findings to diverse populations Intervention's other effects Economic impact Barriers to implementation of interventions

The Guide to Community Preventive Services T he steps for obtaining and evaluation evidence into recommendations involve: Searching for and retrieving evidence on effectiveness Assessing the quality of and summarizing the body of evidence Translating the evidence into recommendations Considering information on evidence other than effectiveness Identifying and summarizing research gaps.

The Guide to Community Preventive Services Summary and recommendations on Website in standard formats Background systematic reviews published in Am. J. Prev. Med. Links to Am. J. Prev. Med. And MMWR materials on Website Links vary in effectiveness

Guide to Community Preventive Services: Diabetes Recommendations Table

GCPS: Oral Health Organization of Links

Register of Reviews of Effectiveness in Health Promotion Maintained by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) Part of the Institute of Education, University of London. 700 reviews currently referenced (citation only) References Cochrane reviews

Cochrane Database of Systematic Reviews Separate Public Health Group Standardized approach to systematic reviews Individual or institutional subscription required for access to full text About 50 reviews and many more planned

Cochrane Review Index (Ovid)

CDC Recommends: The Prevention Guidelines System Over 400 documents Up-to-date guidance on many public health issues Full text or links Most published in MMWR Sophisticated search engine Limited indexing within documents

Systematic Reviews, Meta-Analyses and Evidence-Based Guidelines Possible applications in Public Health: Strengthening, expanding, connecting, and improving indexing of public health models cited may be an attractive approach

Systematic Reviews, Meta-Analyses and Evidence-Based Guidelines Issues: Systematic review methodologies and methods for rating evidence are increasingly well developed. Guidelines can be evidence-based, justified by systematic review, and also accessible and immediately relevant to practice.

Comprehensive Knowledge Bases Formats: Paperback and hardback books with indices for searching Book content on websites and CD-ROM with electronic indices and search options based on the hardcopy index Collections of books on website with comprehensive searching across texts –MD Consult

Comprehensive Knowledge Bases Collections of multiple, carefully selected databases, full text journals and texts –Selective search across databases with prioritized display of findings –Stanford Skolar MD, Merck Medicus

Comprehensive Knowledge Bases Original electronic textbooks (CD-ROM and online, without hard copy equivalent) –Original content prepared and organized to facilitate rapid finds of specific information –May include other databases or texts –Sophisticated indexing displays and search engines –Cross-referenced links within/between chapters –External links to article abstracts of references, etc. –ACP Pier Online, eMedicine, Harrison's Online, Praxis MD, Sci. Am. Med., UpToDate

Comprehensive Knowledge Bases Quality: Dependent on methodology of editors and writers for original content Dependent on selection of databases and texts for nonoriginal content

Comprehensive Knowledge Bases Updating: New editions periodically for texts or new additions to databases Monthly or more frequent updates based on ongoing comprehensive literature review Updating usually involves integrating new knowledge into the existing text structure for those with original content

Comprehensive Knowledge Bases Pushing: Selected new content can be pushed or promoted on a home page

Comparative Study of Comp. Knowledge Bases, Medline, Collections of Systematic Reviews* Standard set of clinical questions used to assess 14 sources including 9 comprehensive knowledge bases Scored on effectiveness (valid, specific answers to the questions) and efficiency (ease of finding answer and time) Comprehensive Knowledge Bases all score above Medline and Systematic Reviews for efficiency *Berkowitz LL. Review and evaluation of internet-based clinical reference tools for physicians, 2002.

Comparative Study of Comp. Knowledge Bases, Medline, Collections of Systematic Reviews* Six Comprehensive Knowledge Bases score above Medline and Systematic Reviews for effectiveness Top 3 for efficiency: UpToDate, ACPR Pier Online, Harrison’s Online Top 3 for effectiveness: UpToDate, eMedicine, Stanford Skolar MD *Berkowitz LL. Review and evaluation of internet-based clinical reference tools for physicians, 2002.

UpToDate: Comp. Knowledge Base Example Topics: Adult Primary Care, Cardiology, Drug Information Endocrinology, Family Practice, Gastroenterology, Gynecology, Hematology, Hepatology, Infectious Diseases, Nephrology, Obstetrics, Oncology, Pulmonology, Rheumatology, Women's Health In Development : Allergy/Immunology, Neurology, Pediatrics

UpToDate: Comp. Knowledge Base Example Initial cards created by consulting staff of >7000 content experts In some cases review by practitioners Extensive editing for consistency by in-house staff of physicians and editors Monthly review of 300 key journals by in-house staff Content experts receive any important new studies and must update their card/s Authors/editors encouraged to use evidence-based methodologies and cite high quality references but no specific evidence criteria

UpToDate

Comprehensive Knowledge Bases Public health examples: Textbooks of Public Health and related disciplines

Comprehensive Knowledge Bases Possible Public Health Applications: Consolidating most useful Public Health online resources (Cochrane, guidelines, reviews, journals) and offering integrated search and improved indexing could improve access. A comprehensive, regularly updated, well indexed electronic knowledge base including original content aimed at common public health questions could be useful. Guide to Comm. Prev. Serv. And Cochrane offer attractive core.

Comprehensive Knowledge Bases Issues: Consolidating databases and developing an effective, efficient search engine is difficult. Both initial and ongoing costs may be prohibitive especially for developing original content. Large numbers of writers and editors required for original content. Consistency in treatment of evidence difficult to achieve in original content.