Monthly Archives: September 2016

MACMLA 2016: Diversity and Disparities: Opportunities and Challenges for 21st-Century Health Care

  • Under-represented groups represent 34% of the total population
  • Diversity in health care work force
    • Physicians: 7%
    • Nurses: 3%
    • Pharmacists: 3%
  • No Ivy League schools are among top medical schools that American Indians, Alaska Natives, or African Americans apply
  • Top medical schools for Hispanic or Latino schools are all in Puerto Rico
  • Business case for diversity in science
    • Birds of a feather research together — and produce research in journals with lower impact factors and less cited
  • Implicit association test https://implicit.harvard.edu/implicit/takeatest.html 
  • 16% of NIH grant applications from black researchers succeed vs 29% from whites
  • AAMC report on state of women in medicine lacked any mention of intersectionality
  • Four patterns of gender bias
    • Feel need to “prove” our competence
    • Walking the tightrope between too aggressive vs too feminine/weak
    • Motherhood penalty
    • Queen bee syndrome (women who refuse to mentor the next generation)
  • JHU Institutional Plan to address
    • Faculty Diversity Action Plan
    • Diversity Advocate
    • $25M JHU Diversity Initiative
    • 54 URM Faculty hired in FY15-16
    • 3 women dept directors
    • 3 URM dept directors
    • Pipeline programs -HCOP, SARE
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MACMLA 2016: Paper Session 1

Building a Critical Mass of Systematic Review Authors and Teachers: A Collaboration between Librarians and Faculty

  • What is the rate of systematic reviews for comparable institutions (those without med schools)?
  • Need to meet with Deans, Directors, Faculty to determine needs
  • Work with researchers on currently publishing SRs & MAs
  • Interest in non-HS programs like Educational Technology, Psychology/Counseling, Statistics, & College of Liberal Arts (ex: Health Care Ethics)
  • Grant from NNLM for on-campus event for training on SRs
  • Created LibGuide and online community for on-going support (basic focus but decent guide usage even before official launch)
  • Speakers were a combination of experts and local researchers
  • Workshop topics
    • Importance of SRs, process
    • Breakout sessions on meta-analysis, integrating EBP into teaching
    • Panel discussion on opportunities and barriers
  • Librarian training
    • 3 options: UofMichigan workshop, Pitt program, applied project for university conference
  • Workshop attendance filled in days (n=27)
  • SRs in Education
    • class presentation, UG research symposium, critically appraised topics, IPE Health Research Skills course

Assessing Value of Library Services on Research, Clinical Practice, Education, and Administration

  • Had done Library Values survey 5 years prior
  • Benefits of informationists services (overall results, but different audiences have different rates per category)
    • information search (56%)
    • point of use instruction (19%)
    • citation management (9%)
    • publication/grant prep (4%)
  • students rank coursework as the highest indicator for intended use of library resources
  • What resources people used with and without informationists
    • with Informationists, more likely to use more resources, and resources like CINAHL, Embase, etc
    • without, more likely to use Google or Dynamed

MEDLIB 2011-2016

  • 5 year analysis of content and comparison with 1997 article analysis
  • as of 2016, MEDLIB-L has ~2000 subscribers (35% education domains, 23% healthcare orgs/hospitals)

One systematic review software to rule them all — NOT!

  • EndNote web works terribly for researchers across different institutions
  • Mendeley sinks beautifully across users but does not have as much space for PDF space (without payment)
  • RefWorks crashed with large RIS file due to timeout
  • SRAssistant deduplication – unsure how well it works
  • **checkout expert searching listserv
  • RefMan only available to Cochrane reviewers
  • SRDR wonderful but clunky due to framing
  • Covidence – can’t have more than 1 person assigned to an article; after 2nd reviewer, then the article moves out of the pool of review

 

MACMLA 2016: Using Data to Improve Clinical Outcomes — Examples and Lessons Learned from Cleveland OH

  • Started with EHR in 1999 (some patients have up to 17 years  worth of data in the EHR)
  • Broader use with 2012 for enterprise-wide EHR adoption – starting with Meaningful Use 1 and progressed forward
  • Paper health records:Hammer :: Electronic health records:Power nail gun — increased power due to tech, but also large potential for more problematic outcomes
  • Case #1 of EHR’s potential – identifying the significant underdiagnosis of hypertension in children — data was available but just not applied
    • Response: Put in an alert to better identify/highlight existence of data
    • Baking the evidence based guidelines into the EHR (CDSS)
      • 38% decrease in false positives
      • 100% increase in provider recognition of abnormal blood pressure
    • Answer: Alerting helps, but not the total fix
  • Case #2 – Immunizations
    • Over 300 immunization rules for children — how do you know if your patient has completed their schedule?
    • Messaging algorithm to reach out to patients using TeleVox about immunization follow up
    • Messages helped increase results by 1/4, but not a perfect fix for the other 3/4
    • Number needed to message 4 people to get 1 immunized
    • $5k in messaging costs led to $200k clinical revenue
    • Personal Health Records
      • Patients will be the biggest amount of EHR users in the future
      • PHR allows for reminders, health info exchange (ex: immunization)
  • Case #3 – Meeting referral drop-off between obesity clinic to specialist
    • 76% referred but never seen
    • So what is the actual appointment follow through within a month after referral? 48%
    • Solutions: self-scheduling + giving specialists a list of patients so they know who is referred and they can take over outreach
    • Moved to 61% after new interventions (6700/month initial consults = $1mil
  • Case #4 – Depression Screening
    • Advanced CDSS for subjective data
    • Use PHQ-9
  • Case #5 – Health Information Exchange
    • Who is likely to have their data exchanged?
      • Older people, female, African Americans, Medicare/Medicaid
    • +1 mil patient records a day exchanged among those on EPIC system
  • Case #6 – Longitudinal diabetes data
    • Synopsis report of data overtime

Q&A notes

  • Information is getting smarter to not just be one click away to Micromedex or UpToDate as a general resource, but one click away from the specific drug entry in Micromedex or UpToDate
  • People in health care do not value information and its integration well into clinical practice — how do we change this paradigm? Informaticists
  • What are the opportunities for librarians to offer education on informatics/EHR competencies
  • Re: alert fatigue – who should the alert be going to? Is adding more info to the 15 min visit overload? What would be a better time? How actionable are these alerts that are provided in the visit?
  • 100% of privacy/security is not realistic, but we need processes in place like credit reports to help manage the inevitable

Follow up readings