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