Using Outcome Measures to Assess the Information Seeking Behavior of Clinicians After Access to Online Resources: A Longitudinal Cohort Study. Nancy H. Tannery, MLS Charles B. Wessel, MLS Barbara A. Epstein, MSLS, AHIP Health Sciences Library System Cynthia S. Gadd, PhD Center for Biomedical Informatics University of Pittsburgh

Health Sciences Library System University of Pittsburgh Purpose To measure how users, in a rural hospital setting, are changed as a result of their contact with online library resources.

Health Sciences Library System University of Pittsburgh Study Design  Longitudinal cohort study  Self-reflective surveys, sent at the initiation of online information services and one year later

Health Sciences Library System University of Pittsburgh Health Sciences Library System (HSLS)  Large academic library system serving University’s six health sciences schools, as well as 17 hospitals of the University of Pittsburgh Medical Center (UPMC) located throughout Western Pennsylvania  UPMC hospitals contract with HSLS for access to licensed online resources (HSL Online)

Health Sciences Library System University of Pittsburgh UPMC Horizon  374 beds on 2 campuses (Greenville, PA & Farrell, PA) – rural area north of Pittsburgh  Founded in 1906; merged with UPMC in 1998  Clinical strengths in primary care and emergency medicine, cardiology, oncology, ophthalmology, sleep disorders, orthopedics, maternity, rehabilitation, arthritis, chemical dependency  3 Residency programs in General Surgery, Internal Medicine and Family Practice  No librarian or organized library!

Health Sciences Library System University of Pittsburgh HSL Online  electronic journals  400+ electronic textbooks  Ovid Medline, PubMed, PsycINFO, CINAHL, AMED, EBM Reviews, and more…..  MICROMEDEX, MDConsult, Embase.com, UpToDate, and more….

Health Sciences Library System University of Pittsburgh Timeline  Fall 2001  UPMC Horizon initiates contract with HSLS for access to HSL Online  Introduction of HSL Online at UPMC Horizon  Winter 2001  Baseline survey sent to clinical staff  Information interventions; instruction, marketing, issuance of passwords  Winter 2002  Follow-up survey was sent to those who had returned the first survey

Health Sciences Library System University of Pittsburgh Self-Reflective Survey  Demographics: age, gender, role  Frequency of computer use, Web use  Use of HSL Online  How clinical information was obtained  Influence of access

Health Sciences Library System University of Pittsburgh Survey Distribution  January 2002: baseline survey sent to 864 physicians, nurses, other clinical staff including pharmacists, social workers and others, 47% response rate (n=408)  January 2003: follow-up survey sent, 55% response rate (n=226).

Health Sciences Library System University of Pittsburgh Characteristics of Population  43 physicians (21 MD’s/22 DO’s), 116 nurses, 56 others n=215  18 physicians, 21 nurses, 16 others used HSL Online n=55  No demographic differences

Health Sciences Library System University of Pittsburgh Computer Use MD’s and DO’s

Health Sciences Library System University of Pittsburgh Computer Use MD’s and DO’s Comparison after one year - No significant change in computer use - Increase in Web use 15% MD 16% DO (p=0.026)

Health Sciences Library System University of Pittsburgh HSL Online Users: How Do They Find Clinical Information

Health Sciences Library System University of Pittsburgh Information Seeking Behavior  Locating a specific answer to a question  physicians 94%, nurses 67%, other 87% (p=0.07)  More effectively consulting the literature  physicians 61%, nurses 24%, other 60% (p=0.03)

Health Sciences Library System University of Pittsburgh Clinical Decision Making Behavior  Prescribing drugs  physicians 44% (p< 0.001)  Ordering/not ordering a test  physicians 61% (p<0.001)  Preventing a drug interaction  physicians 33%, nurses 9.5%, other 40% (p=0.08)

Health Sciences Library System University of Pittsburgh Conclusion Access to online library resources resulted in the following outcomes:  Increase in computer use  Changes in information seeking behavior  Changes in clinical decision making behavior

Health Sciences Library System University of Pittsburgh Strengths and Limitations  Longitudinal design  User group  Small sample size  Self reporting

Health Sciences Library System University of Pittsburgh Next Steps  Third survey sent January 2004  Training and marketing to non HSL Online users  Present findings to hospital administrators