This document outlines a project to provide public health departments with improved access to trusted library resources. It identifies core resources that will be made available through a digital library interface. Partnerships have been established with state public health departments and hospital/academic libraries. Training has been provided to public health workers on literature searching and evidence-based practice. Usage data shows that resources are being utilized, especially journals in key topic areas. The project enhances evidence-based public health practice through improved access to scientific literature and guidelines. Evaluations indicate the resources and training are supporting public health workers' competencies and job functions.

1. Karen Dahlen, Project Consultant
Elaine Martin, Director
New England Region NN/LM Lamar Soutter Library
University of Massachusetts Medical School

2. Why This Project : Goals & Technology
Relationship to National /State Initiatives
Selected Resources Tied to Sources of Evidence
Work Within Existing Environment

3. 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.


4. Competencies Defined By
PHF/Council on Linkages

Analytic/Assessment Skills
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Policy Development/Program Planning 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.
Analyzes information relevant to specific
public health policy issues
Project Tied to Competencies

Knowledge Informatics
› Improve access to trusted resources
›
›

Informatics Skills
› Introduce interoperable features that
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.
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.
›
›
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.

5. Maryland DHMH Health Initiatives

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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 Diseases
Hepatitis C Virus (HCV)
HIV Infections
--HIV and HCV Co-Infection
*ACA –Affordable Care Act

6. 
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Identify core, useful, trusted e-resources to State
Departments of Health to improve evidencebased 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)

7. 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.


8. Objective

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
Subjective
From: Evidence-Based Public Health, A Course in Chronic Disease Prevention
Ross C. Brownson PhD

9. 
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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.

10. Overall Project Plan
Resources & Tools Currently Being Tested
Partnerships & Digital Libraries in Place
Training Agenda/Trainings Held
Ongoing Evaluation Processes

11. 

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
Timely
Information
in Support of
EvidenceBased
Alternate
Article
Delivery
via
Libraries
Public Health
Practice

12. 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
MA
Maine CDC
Boston Public Health Commission*
Maine Medical Center Library
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

13. Factors Influencing Rule
(Collective Data)
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
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%
395
40
10%
*1500
150
10%
NH DHHS
279
30
10%
RIDH
400
40
10%
VDH
350
35
10%
WDPHS
400
40
10%
Maine CDC
MDPH

14. 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


15. Single Titles (14) – Societies +

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

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)
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


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)

16. 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

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
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
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)

17. 
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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.

18. Information Need Related to Work Task
HI, AK, HI, IN, MA, MD=1514
1200
1119
1000
800
600
400
200
0
851
643
819
718
698
577
393
539
564
455
380
227
151

19. Connecticut Department of Public Health
Arkansas Department of Health

20. Alaska Division of Public Health
Hawaii State Department of Health

21. 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.

22. 
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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)

23. Use of Resources & Cost Efficiencies
New Resources & Preliminary Data
Training: Content & Summary
Lessons Learned & Outcomes
Enterprise Cost Efficiencies

24. NEJM Use by 15 PHDs
Public Health May 2011Department Apr 2012
Jan 2013July 2013
8000
6000
4000
2000
0
May 2011-Apr 2012;
N=13,173
715
406
BPHC
371
337
NH DHHS
553
316
CDPHE
754
223
7078
3112
RIDH
731
415
CT PHD
1713
1603
KY DPH
10000
792
MPHD
Jan-Jul 2013; N=9823
1179
Maine CDC
12000
VDH
79
665
ADH
0
239
WI DHS
0
954
ISDH
Maryland
DHMH
0
178
0
520
HI DPH
0
63
0
13173
0
9823
AK DPHS
Total

25. Total Use by Each PHD
PHDs
MDPH
CT DPH
KY DPH
ADH
MDHMH
Maine CDC
VDH
WI DPH
RIDH
AK DPH
CDPHE
NH DHHS
BPHC
HI DPH
Total
1830
1256
1066
1006
741
736
660
656
572
514
486
184
178
59
High Use 13 OUP Titles
Journal Title
Total
Clinical Infectious Diseases
American Journal of Epidemiology
Schizophrenia Bulletin
JNCI: Journal of the National Cancer
Institute
ICES Journal of Marine Science
The Journal of Infectious Diseases
International Journal of Epidemiology
Journal of Antimicrobial
Chemotherapy
Nephrology Dialysis Transplantation
Journal of Analytical Toxicology
Annals of Oncology
Toxicological Sciences
Journal of Pediatric Psychology
1412
513
393
343
269
259
184
156
151
128
100
98
95

26. Title
BMJ
Use of Journals added in
May, 2013
 Represents 8 different
publishers
 Journals contain topical
interest of public health
workforce

#Uses
1031
American Journal of Clinical
Nutrition
450
Tobacco Control
285
Journal of Antimicrobial
Chemotherapy
200
Diabetes Educator
93
Annual Review of Public Health
Archives
87
The Journal of School Nursing
83
Health Promotion practice
83
Journal of General Internal
Medicine
75
Archives of Environmental
Contamination and Toxicology
36

27. Total Use=632
22 Documents Sept 2013
N=23

28. 

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

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

29. Training Topics – Day 1

Welcome & Overview
Public Health Leadership
Training Topics – Day 2

Review of Digital Library Page**

Introduction to Cochrane Library
& Systematic Reviews

Project Introduction

Why Evidence-Based Public
Health*

Alternative Article Delivery
Service

NLM’s PubMed Database

Introduction to Global Health

Introduction to EndNote 7

Introduction to STAT!Ref

Practicum Computer Lab
Assignment

Review of EndNote 7

Brief Info about NIH RePORTER

Practicum Computer Lab
Assignment
Total of 7.0 Hours Training
Two Days: Back to Back

30. STATE
PHD
Trainings
Attendance
Maryland
Indiana
Hawaii
Nutrition
Specialist (2)
State
Epidemiologist
Education
Coordinator (2)
52
Research
Statistician
Supervisor – Labs +
(3)
Asthma
Coordinators(2
58
Injury Prev
Epidemiologist
Legislative Liaison
4
Policy Analyst
(2)
3
32
Program Mgr (2)
Staff Attorney
Epidemiologist
MPHD*
NH
NH DHHS
2
24
Epidemiologist
Microbiologist ( 2)
CO
CDPHE*
5
100
Research Analyst
(2)
Medicare
Specialist/Advis
or (2)
Regional Program
Director
Program
Coordinator, SAPB
RI
RIDH
2
30
VT
3
46
ME
VDH
MAINE
CDC*
MA
BPHC*
MA
3
CT
CT DPH*
5
101
KY
AR
KDPH
ADH
2
2
46
31
Policy Advisor
(2)
Director of Prog
Evaluation
Epidemiologist (3)
WI
WI DPH
2
33
Psychiatric VT
Genetic Counselor
AK
AK DPH
2
50
Director of Prog
Development
68
Field Epi Director
HI DPH
2
Executive Ass’t
HI
Tobacco Prevent
Mgr
IN
ISDH
2
60
MD
MDHMH
38
Access Services
Mgr
Informatics Analyst
2
Deputy
Secretary
41
769
Director VSA
IT Supervisor
Nutritionist
TOTAL
15

31. Journal Title
# Uses
Cost
Per Use
Replacement
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
Public Health Reports
638
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

32. May 2011 – April 2012; Cost=$18,384
May 2012 --- April 2013; Cost=$12,241
ILL
DD
Total
2
20
22
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
STATE
STATE
Maine
Massachusetts
(BPHC)
0
0
0
462
593
1055
DD
Total
0
83
83
Connecticut
560
Connecticut
ILL
364
924
Maine
11
8
3
Massachusetts
(MDPH)
1
1
2
New Hampshire
0
0
0
Rhode Island
47
36
83
Vermont
21
191
212
Colorado
323
156
479
960
834
1794
Total
Total
Article Delivery Costs Via Library Partnerships

33. Direct Access to Articles
Alternative Article Delivery
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
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

34. 
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


35. 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.”
