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Evidence-Based Practice for Public
Health ProjectFunded by a
CDC/ATPM Cooperative Agreement
Lamar Soutter LibraryPrincipal Investigator: Elaine Martin, MSLS, MAProject Coordinator: Hathy Simpson, MPHProject 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 Studies1. Systematic reviews of multiple valid
intervention studies2. One or more randomized controlled
trials or other intervention studies3. Systematic reviews of multiple valid
observational studies or evaluations4. 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
Proposed Knowledge Domain of
Public Health
Accreditation Criteria, Council on Education for
Public Health, Knowledge Areas
Maxcy-Rosenau-Last Public Health
& Preventive Medicine Chapters
American Journal of Public Health,
Collection Categories
The Public Health Work Force,
Enumeration 2000 Occupational
Categories
Massachusetts Dept. of Public
Health, Bureaus & Programs
American Public Health
Association, Sections & Special
Interest Groups
Health People 2010,
Focus Areas & Leading Health
Indicators
The Guide to Community Preventive Services, Topics
Public Health Functions
Working Group, Essential Public Health Services
NLM, Journal Subject
Headings
NLM, Medical Subject
Headings
Library of Congress
Subject Headings
Environmental Health
Toxicology Hazardous Materials Ecology Environmental Microbiology Environmental Monitoring Environmental Epidemiology Industrial & Land Pollution
Environmental Health Sciences
Biological Factors Physical Factors Chemical Factors
Environmental Health
Toxicology
Environment Environmental Engineer
Environmental Engineer Technician Chemical Engineer Testing Technician Environmental
Scientist & Specialist
Environmentalist Environmental Science & Protection Technician Environmental Health Specialist Soil & Plant Scientist Hazardous Materials Specialist Toxicologist
Environmental Health Assessment
Community Assessment Program Environmental Health Education Program Environmental Epidemiology Program Environmental Toxicology Program
Environment
Environmental Health
Toxics & Waste Infrastructure & Surveillance Environmental Quality
Diagnose and Investigate Health Problems
Enforce Laws and
Regulations Follow-up of Hazards & Exposure-related Diseases
Public Health Environmental
Health Ecology Pollution Toxicology Pesticides Poisoning Xenobiotics
Environmental Health
Environmental
Medicine Environmental
Microbiology Air Microbiology Food Microbiology Soil Microbiology Water Microbiology Environmental
Pollution Environmental
Monitoring Disorders of
Environmental Origin
Environmental Health
Environmental Toxicology Environmentally Induced Diseases Environmental
Engineering Environmental Monitoring Environmental Testing
Outdoor Air Pollution
Air Pollution Engineer, Technician Air Pollution Specialist
Outdoor Air Quality
Enforcement of Clean Air Standards
Air Pollution Air Pollution
Indoor Pollution - Housing &
Health - Buildings &
Health - Lead Poisoning - Asbestos - Radon in Homes
Housing & Health Indoor Air Quality Childhood Lead Poisoning Prevention Program
Healthy Homes & Healthy Communities
- Indoor Allergens - Office Building Air Quality - Radon in Homes - Lead-based Paint - Substandard Housing
Air Pollution, Indoor Housing
Housing & Health Asbestos
Abatement Lead Abatement
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 JournalsIdentified
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
http://library.umassmed.edu/ebpph
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 YearContinued
• 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
PersonnelPrincipal Investigator: Elaine Martin, MSLS,
MAProject Coordinator: Hathy Simpson, MPHProject Consultant: Roger Luckmann, MD,
MPHProject Consultant: Sharon Telleen, PhDTechnical Advisor: Jocelyn Rankin, PhD
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