Taneya Y. Koonce

Evolution of a Mature Clinical Informationist Model

Achieving evidence-based practice will require new approaches to providing information during health care delivery and to integrating evidence and informatics at the point of care. To support evidence-based practice, Vanderbilt University Medical Centers Eskind Biomedical Library (EBL) introduced the role of clinical informationist, an information specialist with sufficient knowledge and insight to function as a true partner in the health care team. To further disseminate evidence-based knowledge, the Vanderbilt University Medical Centers (VUMC) electronic medical record system and pathway development processes integrate advanced information synthesis capabilities provided by clinical informationists. Combining clinical informationist expertise with informatics tools is an effective strategy for delivering the evidence needed to support patient care decisions.

Guiding Oncology Patients Through the Maze of Precision Medicine

As the role of genomics in health care grows, patients increasingly require adequate genetic literacy to fully engage in their care. This study investigated a model for delivering consumer-friendly genetic information to improve understanding of precision medicine using health literacy and learning style principles. My Cancer Genome (MCG), a freely available cancer decision support tool, was used as a testbed. MCG content on a melanoma tumor mutation, BRAF V600E, was translated to a 6th-grade reading level, incorporating multiple learning modalities. A total of 90 patients and caregivers were recruited from a melanoma clinic at an academic medical center and randomized to 3 groups. Group A (control) received an exact copy of text from MCG. Group B was given the same content with hyperlinks to videos explaining key genetic concepts, identified and labeled by the team as knowledge pearls. Group C received the translated content with the knowledge pearls embedded. Changes in knowledge were measured through pre and post questionnaires. Group C showed the greatest improvement in knowledge. The study results demonstrate that providing information based on health literacy and learning style principles can improve patients’ understanding of genetic concepts, thus increasing their likelihood of taking an active role in any decision making concerning their health.

Institute of Medicine Measures of Social and Behavioral Determinants of Health: A Feasibility Study

INTRODUCTION Social and behavioral factors are known to affect health but are not routinely assessed in medical practice. To date, no studies have assessed a parsimonious panel of measures of social and behavioral determinants of health (SBDs). This study evaluated the panel of SBD measures recommended by the Institute of Medicine and examined the effect of question order. METHODS Adults, aged ≥18 years, were recruited using ResearchMatch.org for this randomized, parallel design study conducted in 2015 (data analyzed in 2015-2016). Three versions of the SBD measures, sharing the same items but in different orders of presentation (Versions 1-3), were developed. Randomized to six groups, participants completed each version at least 1 week apart (Weeks 1-3). Version order was counterbalanced across each administration and randomization was stratified by gender, race, and age. Main outcomes were effect of question order, completion time, and non-response rates. RESULTS Of 781 participants, 624 (80%) completed the Week 1 questionnaire; median completion time for answering all SBD questions was 5 minutes, 583/624 participants answered all items, and no statistically significant differences associated with question order were observed when comparing responses across all versions. No significant differences in responses within assignment groups over time were found, with the exception of the stress measure for Group 5 (p=0.036). CONCLUSION Question order did not significantly impact participant responses. Time to complete the questionnaire was brief, and non-response rate was low. Findings support the feasibility of using the Institute of Medicine-recommended questionnaire to capture SBDs.

National Academy of Medicine Social and Behavioral Measures: Associations With Self-Reported Health

INTRODUCTION Social and behavioral factors play important roles in physical and mental health; however, they are not routinely assessed in the healthcare system. A brief panel of measures of social and behavioral determinants of health (SBDs) were recommended in a National Academy of Medicine report for use in electronic health records. Initial testing of the panel established feasibility of use and robustness of the measures. This study evaluates their convergent and divergent validity in relation to self-reported physical and mental health and social desirability bias. METHODS Adults, aged ≥18 years, were recruited through Qualtrics online panel survey platform in 2015 (data analyzed in 2015-2016). Participants completed the (1) panel of SBD measures; (2) 12-Item Short Form Health Survey to assess associations with global physical and mental health; and (3) Marlowe-Crowne Social Desirability Scale short form to assess whether social desirability influenced associations between SBD measures and self-reported health. RESULTS The sample included 513 participants (mean age, 47.9 [SD=14.2] years; 65.5% female). Several SBD domain measures were associated with physical and mental health. Adjusting for age, poorer physical and mental health were observed among participants reporting higher levels of financial resource strain, stress, depression, physical inactivity, current tobacco use, and a positive score for intimate partner violence. These associations remained significant after adjustment for social desirability bias. CONCLUSIONS SBD domains were associated with global measures of physical and mental health and were not impacted by social desirability bias. The panel of SBD measures should now be tested in clinical settings.

Strategically aligning a mandala of competencies to advance a transformative vision

OBJECTIVE This paper offers insight into the processes that have shaped the Eskind Biomedical Librarys (EBLs) strategic direction and its alignment to the institutions transformative vision. SETTING The academic biomedical library has a notable track record for developing and pioneering roles for information professionals focused on a sophisticated level of information provision that draws from and fuels practice evolutions. STRATEGY The medical centers overall transformative vision informs the creation of a fully aligned library strategic plan designed to effectively contribute to the execution of key organizational goals. Annual goals reflect organizational priorities and contain quantifiable and measurable deliverables. Two strategic themes, facilitating genetic literacy and preserving community history, are described in detail to illustrate the concept of goal setting. CONCLUSION The strategic planning model reflects EBLs adaptation to the ever-changing needs of its organization. The paper provides a characterization of a workable model that can be replicated by other institutions.

Synthesis of informatics literature to support institutional policy statement development

The Journal of the Medical Library Association (JMLA) case study column provides health sciences librarians with information searching, retrieval, and filtering scenarios in various settings. In previous issues, cases in this series have explored specific patient-care complex questions from clinical teams [1] and best practices for departmental diagnostic decision making [2]. This issues case explores synthesizing information from the literature to support administrative decision making in health care.

Reflections on the Journal of the Medical Library Association

As we conclude our term as the editorial team of the Journal of the Medical Library Association (JMLA), we have reflected on the goals that led us to take on the challenge of editing the journal. First and foremost, we wanted to contribute to the education of health sciences librarians and help to broaden the professions skill set. The “JMLA Case Studies” column that the team inaugurated has played a role in doing so through putting forth a challenging question and leading readers through the processes of locating and summarizing evidence to address it. This months case study broadens the focus to address a genetics-focused question dealing with supporting virology and evolution-related research and is contributed by an expert from outside Vanderbilt University. In addition, the team actively solicited editorials from varied perspectives to ensure that a wide range of viewpoints and issues were addressed. Our term has seen editorials from hospital and academic medical center librarians, library and information science educators, and national library leadership, among others [1–4]. Our second major focus has been on continuing work to foster a research mentality among JMLA readers. To assess patterns in research publication, we completed a semi-systematic review of papers published in the JMLA from 2002–2007. Three team members independently examined articles published annually in the 2002–2007 time frame and categorized them as research (defined generally as a systematic investigation of a focused question with analysis and reporting of gathered data) or non-research. Research articles were further categorized by type (e.g., citation analysis, program evaluation, etc.). Research papers generally increased in proportion, constituting more than half of all papers published since 2003 and at least 60% of papers since the Eskind Biomedical Library teams editorial tenure began in 2006 (Table 1). Table 1 Research papers published annually in the Journal of the Medical Library Association (JMLA), 2002–2007 Our efforts to continue to improve the quality and research focus of papers in the journal have necessarily resulted in a more competitive acceptance rate: the teams acceptance rate has consistently hovered around 50% (52% for 2007). While no editor enjoys turning away papers, we have been gratified to see that continuing growth in the quality and breadth of the body of health sciences literature allows increased discernment in assessing papers for publication. In the process of working with authors to improve the quality of submissions, we have also been able to improve our own workflow. In 2006, we reported that authors submitting papers received an initial decision and comments in less than 1 month following submission and peer review approximately 55% of the time. In 2007, the turnaround rate improved such that these initial decisions were delivered in less than 30 days 72% of the time. Of course, much of the work of the JMLA depends on the dedication of our volunteer peer reviewers. We have been privileged to work with many talented reviewers and associate editors over our term and thank them all for their contributions to the JMLA. We particularly thank those reviewers who addressed the largest volume of manuscripts over the past three years for contributing their time and expertise. We must also thank the Medical Library Association (MLA) publications staff and leadership for their assistance and dedication to a high-quality journal and, of course, the readers of the JMLA for your encouraging comments on the changes in the journal. We also thank the authors who submitted papers and graciously worked with us through the revision process. The journal, and ultimately the profession, thrives on your interesting ideas and thoughtful investigations into ways to improve our services. In our work with authors to help clarify elements of papers, we have been struck by the number of authors who have expressed their deep appreciation for this kind of mentorship and opportunity to collaborate with other writers. While some libraries undoubtedly have supportive mentoring cultures and promote such collaboration, providing a forum for volunteer mentors with demonstrated expertise in research and scholarly publication to interact with authors seeking mentorship might be a useful idea for an organization like MLA to pursue. Working with the journal has provided us a wonderful opportunity to develop our own skills and knowledge, and we have appreciated the opportunity to learn from the thought-provoking conceptions and hypotheses that JMLA authors have developed over the last three years. The JMLAs new editor, Susan Starr, former associate university librarian for sciences and scholarly communication at the University of California, San Diego, brings with her interesting ideas about further developing the journals electronic content and position as a vehicle for knowledge sharing and mentoring. She noted in her application: [The JMLAs editor] will be well positioned to exploit the power of electronic delivery to strengthen the online JMLA by adding features and additional content. We should be as proud of our journal in its web incarnation as we are of the print vehicle. However, the move to electronic publishing is not without its challenges. In the online era, individuals increasingly only go to the literature when they have a particular problem to address, rather than regularly scanning the content of the key journal in their field. The user focuses on individual articles on a particular topic, wherever they are published, and the value of the journal as journal declines. Unfortunately, though understandable, this behavior causes individuals to miss much in the literature that could assist them. One challenge that the new editor will face is to develop tools and techniques that will assure that our members continue to access the knowledgebase that the JMLA represents. The JMLA serves as a useful tool for addressing these and other issues related to information and communication, and as the new editor develops the JMLA further, we look forward to continuing to learn from the insightful thoughts conveyed in it.