Evaluating the impact of library services on the quality and cost of medical care

Recent federal regulations have minimized the role of the hospital library in contributing to the quality of medical care and in lowering hospital costs. We trace the events that have led to these assumptions and discuss the complex problem of evaluating the impact of library services. Current research on the value and effectiveness of information is outlined.     

The value and impact of information provided through library services for patient care: a systematic review

OBJECTIVE: An updated systematic review was carried out of research studies looking at the value and impact of library services on health outcomes for patients and time saved by health professionals. METHODS: A comprehensive systematic search was undertaken of the published literature to September 2003 in ERIC, LISA, MEDLINE, PREMEDLINE, EMBASE, the Cochrane Controlled Trials Register and Google. Some handsearching was carried out, reference lists were scanned and experts in the field were contacted. Twenty-eight research studies of professionally led libraries for health-care staff, including clinical librarian projects, met the inclusion criterion of at least one health or 'time saved' outcome. Papers were critically appraised using internationally accepted criteria. Data were extracted and results were summarised using a narrative format as the studies were heterogeneous and precluded a statistical analysis. RESULTS: There is evidence of impact from both traditional and clinical librarian services. The higher quality studies of traditional services measured impacts of 37-97% on general patient care, 10-31% on diagnosis, 20-51% on choice of tests, 27-45% on choice of therapy and 10-19% on reduced length of stay. Four studies of clinical librarian projects suggested that professionals saved time as a result of clinical librarian input, and two of these studies showed evidence of cost-effectiveness. However, the clinical librarian studies were generally smaller, with poorer quality standards. CONCLUSIONS: Research studies suggest that professionally led library services have an impact on health outcomes for patients and may lead to time savings for health-care professionals. The available studies vary greatly in quality but the better quality studies also suggest positive impacts. Good practice can be gathered from these studies to guide the development of a pragmatic survey for library services that includes the direct effects for patients among the outcome measures.     

The contribution of hospital library information services to clinical care: a study in eight hospitals

Hospital health sciences libraries represent, for the vast majority of health professionals, the most accessible source for library information and services. Most health professionals do not have available the specialized services of a clinical medical librarian, and rely instead upon general information services for their case-related information needs. The ability of the hospital library to meet these needs and the impact of the information on quality patient care have not been previously examined. A study was conducted in eight hospitals in the Chicago area as a quality assurance project. A total of 176 physicians, nurses, and other health professionals requested information from their hospital libraries related to a current case or clinical situation. They then assessed the quality of information received, its cognitive value, its contribution to patient care, and its impact on case management. Nearly two-thirds of the respondents asserted that they would definitely or probably handle their cases differently as a result of the information provided by the library. Almost all rated the libraries' performance and response highly. An overview of the context and purpose of the study, its methods, selected results, limitations, and conclusions are presented here, as is a review of selected earlier research.     

Measuring the value and impact of health library and information services: past reflections, future possibilities

Objectives: To summarize the context, history and results of research studies conducted on the value and impact of health library and information services by the author since 1975 and to use this as a basis for examining ongoing developments related to evaluation research. To provide a comprehensive bibliography of library value and impact studies. Methods: Literature review and background based on personal involvement in the studies under discussion. Results: The author's studies demonstrate an ongoing evolution of value and impact studies since the mid‐1970s. In health sciences libraries, the approach taken to measuring value and impact has been strongly influenced by the type of research being conducted in the health sciences field as a whole. As a result, health sciences library researchers have become early adopters of methods that incorporate outcome and impact measures and rigorous research designs, and the concept of evidence‐based library and information practice. The paper recommends that a range of research approaches from various disciplines be used to guide future evaluation research. Conclusions: Value and impact studies will continue to be important resources for evidence‐based practice as health information professionals deal with evolving user needs and new ways of delivering information to a variety of audiences.     

The value of library and information services in patient care: results of a multisite study

Objective:

The research conducted a large-scale, multisite study on the value and impact of library and information services on patient care.

Methods:

The study used: (1) 2 initial focus groups of librarians; (2) a web-based survey of physicians, residents, and nurses at 56 library sites serving 118 hospitals; and (3) 24 follow-up telephone interviews. Survey respondents were asked to base their responses on a recent incident in which they had sought information for patient care.

Results:

Of the 16,122 survey respondents, 3/4 said that they had definitely or probably handled aspects of the patient care situation differently as a result of the information. Among the reported changes were advice given to the patient (48%), diagnosis (25%), and choice of drugs (33%), other treatment (31%), and tests (23%). Almost all of the respondents (95%) said the information resulted in a better informed clinical decision. Respondents reported that the information allowed them to avoid the following adverse events: patient misunderstanding of the disease (23%), additional tests (19%), misdiagnosis (13%), adverse drug reactions (13%), medication errors (12%), and patient mortality (6%).

Conclusions:

Library and information resources were perceived as valuable, and the information obtained was seen as having an impact on patient care.

Highlights

• Library and information resources were perceived as valuable, and the information obtained was seen as having an impact on patient care.
• Electronic access to information resources from multiple locations has increased the ability of health professionals to use these resources for improved patient care.
• The roles of librarians are diversifying to include management of electronic resources, user instruction and support, specialized research and clinical information search services, and involvement in institution-level quality improvement.
• It is possible to conduct a large-scale, multisite study on the value and impact of library services on patient care.

Implications

• Ongoing studies of the value and impact of library and information resources will be important for advocacy and quality improvement.
• Community-Based Participative Research methods hold promise as a way of ensuring the relevance of future research.

     

Increasing the rural general practitioners' use of library and information services through publicity: a randomized controlled trial in Cornwall, UK

OBJECTIVES: To provide evidence on the effectiveness of publicity with the aim of encouraging general practitioners (GPs) in Cornwall to make better use of the Cornwall Health Library Service (CHLS). In the light of the findings, a second objective was formulated to determine which resources they used to look for health information. METHODS: A cluster randomized controlled trial (RCT) measured the effect of two types of publicity, comparing emails with visiting GP practices. After the trial period, a questionnaire was sent to all 332 GPs to ascertain the resources they accessed for their information and any barriers to their use of the CHLS. RESULTS: The GP's use of the library services was lower than the level needed for a conclusive statistical analysis; however, visiting practices was associated with an apparent increase in library use and warrants further investigation. The questionnaire showed that GPs make good use of databases and colleagues. CONCLUSION: The RCT confirmed the low uptake of library services anticipated, but was inconclusive in demonstrating the most effective form of publicity. The questionnaire suggested that a substantial number of GPs are interested in the library services and has provided an insight into the way that GPs look for information in Cornwall.     

Determining the impact of health library services on patient care: a review of the literature

The impact of health library information has been studied in a number of settings and populations. This review examines both the methods employed and the outcomes reported in a series of impact studies conducted in four countries since the late 1980's. It demonstrates that health library information can affect patient care outcomes in various ways and has high cognitive and clinical value in diagnosing and treating patients. But there remains no agreed technique or methodology for determining the level of this impact. In many cases evaluation of the health library's impact will be located within a central process of evaluation of the greater organization to which the library belongs. Consequently, local ad hoc evaluation is rarely reported outside an organization. The author considers the question of whether it is worthwhile doing an impact study and what form it might take. The author concludes by identifying seminal papers on the topic.     

The value and impact of information provided through library services for patient care: developing guidance for best practice

Introduction: Previous impact tool‐kits for UK health libraries required updating to reflect recent evidence and changes in library services. The National Knowledge Service funded development of updated guidance. Methods: Survey tools were developed based on previous impact studies and a systematic review. The resulting draft questionnaire survey was tested at four sites, and the interview schedule was investigated in a fifth area. A literature search in assia , Google Scholar, intute , lisa , lista , scirus , Social Sciences Citation Index (Web of Knowledge), and the major UK University and National Libraries Catalogue (copac ), identified ways to improve response rates. Other expert advice contributed to the guidance. Results: The resulting guidance contains evidence‐based advice and a planning pathway for conducting an impact survey as a service audit. The survey tools (critical incident questionnaire and interview schedule) are available online. The evidence‐based advice recommends personalizing the request, assuring confidentiality, and using follow‐up reminders. Questionnaires should be brief, and small incentives, such as a lottery draw should be considered. Bias is minimized if the survey is conducted and analysed by independent researchers. Conclusion: The guidance is a starting point for a pragmatic survey to assess the impact of health library services.     

信息时代的图书馆传统业务

本文以剪报为例,论证了在网络时代,图书馆作为文献信息的中心,一些传统的业务及资料保存仍然有存在的必要性,应发挥其应有的作用.     

Evaluating the impact of library user training programmes across Thames Valley Strategic Health Authority in the UK

BACKGROUND: This study was undertaken to provide evidence that library outreach projects in the NHS in the Thames Valley Strategic Health Authority area were effective and could justify continued funding. Objectives: The object was to assess whether information literacy skills training taken up by health professionals impacts on their confidence and skills in using electronic sources of health information. METHOD: A total of 487 health professionals taking up training on a voluntary basis were assessed by completing a self-assessment questionnaire prior to and after training to establish their information literacy skills and confidence levels. Of these, 223 trainees (46%) also returned 6-week follow-up questionnaires. RESULTS: Results showed that 464 trainees (95%) intended to apply what they had learnt in a variety of ways; use of specific resources greatly increased after training and confidence in using them increased substantially. Use of search techniques increased considerably overall, whereas use of Google decreased. CONCLUSIONS: The major findings of this research are that training health-care personnel in the use of electronic resources impacts positively on their information literacy skills and confidence, and that the information available to them is considered to have potential value across health-care practice.     

信息生命周期管理对图书馆信息服务的启示

本文在分析信息生命周期管理理念的基础上，探讨了图书馆可从延长馆藏信息资源生命周期、采用动态藏书模式、分级存储数字资源等方面着手，以提高信息服务质量。     

中小学网上图书馆服务的尝试

论文提出图书馆要改变单一的“借还”服务，充分利用现代技术和现代通信手段，拓展服务功能，进行知识信息的搜集、加工和管理，并提供方便快捷的综合性服务平台。     

Demonstrating the positive impact of information support on patient care in primary care: a rapid literature review

AIM: To review the literature on the positive impact of information services, or information resources, on patient care in primary care. OBJECTIVES: To identify and summarize key papers on which librarians might draw in making the case for investment, and to highlight gaps in the research evidence Methodology: A rapid literature review was conducted in the summer of 2005. RESULTS: There is a small body of evidence to demonstrate the positive impact of library and information services on the direct care of patients as well as a beneficial impact on the care of future patients through the application of evidence to multiple patients. CONCLUSIONS: There is relatively limited research evidence of the impact of information, and library services, in primary care, in comparison with hospital settings and the research available is generally reliant on small samples. There is a lack of impact studies conducted with non-clinical staff. The review highlights the value of critical incident technique (CIT). It is possible to gather evidence of the potential for information services to deliver cost savings.     

Building bridges: towards integrated library and information services for mental health and social care

This research focuses on identifying the information needs of health professionals, social workers and staff from voluntary agencies, who work together in the provision of services for people with a mental illness. The aim is to provide a fully integrated library and information service for mental health and social care. A number of recent government reports have prompted this research. These have culminated in the publication of the National Service Framework for Mental Health. It was decided to conduct a qualitative study using 17 semi‐structured interviews with individuals and multi‐professional groups. A thematic analysis highlighted a number of key themes including: information need, information seeking behaviour and information flows. Results have indicated that because of the dispersed nature of mental health services, across primary and secondary care, and from statutory and non‐statutory organisations, information technology is viewed as the only realistic vehicle to provide the required information. As specialist mental health trusts are configured, covering wider geographical areas, this can only increase the reliance on information technology, for information access and information sharing.     

Planning changes to health library services on the basis of impact assessment

Background: Various methods of impact assessment for health library services exist, including a toolkit developed for the UK. The Knowledge, Resource and Information service (KRIS) for health promotion, health service commissioning and public health (Bristol area, UK) commissioned an independent team at Aberystwyth University to provide an impact assessment and evaluation of their services and to provide evidence for future planning. Objective: The review aimed to provide an action plan for KRIS through assessing the impact of the current service, extent of satisfaction with existing services and views on desirable improvements. Methods: Existing impact toolkit guidance was used, with an adapted impact questionnaire, which was distributed by the KRIS staff to 244 users (response rate 62.3%) in early 2009. The independent team analysed the questionnaire data and presented the findings. Results: Users valued the service (93% considered that relevant information was obtained). The most frequent impacts on work were advice to patients, clients or carers, and advice to colleagues. Literature searching and current awareness services saved staff time. Many users were seeking health promotion materials. Conclusion: The adapted questionnaire worked well in demonstrating the service impacts achieved by KRIS, as well as indicating desirable improvements in service delivery.     

Evaluation of outreach services for primary care and mental health; assessing the impact

Objectives: This paper reports an evaluation, carried out for London Health Libraries, of the impact of outreach services to primary care and mental health workers in 13 different settings. The main aims of the project were to identify the impact being made by the service, and to produce best‐practice guidelines for outreach services in this kind of community setting. Methods: Analysis of documents, analysis of any evaluation already carried out, interviews with outreach librarians, survey of a representative sample of users (eight services). The services evaluated were very diverse in terms of setting, structure, functions and activities. The evaluation was therefore largely qualitative. Emphasis was placed on trying to identify critical incidents, where it could be shown unambiguously that the outreach services made a difference to practice. Findings: Service recipients felt better informed, more up to date, more aware of resources, more confident and supported in their work, and saved time. Direct impacts, such as improved patient care, cost savings, etc., were more difficult to establish. Conclusions: The study identified the main areas of impact, and the main factors which affected this. Recommendations for good practice in such outreach services are made. Lessons of this evaluation for impact studies in general are presented, in particular the difficulty of assessing ‘direct’ impacts.