Managing health libraries

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see also Managing a health library ppts

Health library standards & valuation

Studies of the value of health libraries

Abstract: Health libraries continue to be under increasing pressure to evaluate services and to justify their value. Hospital libraries face a particular challenge because the goals of the health care system demand that the relevance of library services to patient care be determined. The hospital librarians in Rochester, New York, responded to this challenge by developing a research project that explored the impact of library services on clinical decision making. A systematically sampled group of 448 physicians in the Rochester area agreed to participate in the study between September 1990 and March 1991. The physicians were asked to request information related to a current clinical case and then to evaluate its impact on the care of their patients. Senior medical staff acted as study facilitators in each of the fifteen participating hospitals. As a result of the information provided by the library, 80% of the 208 physicians who returned their questionnaires said that they probably or definitely handled some aspect of patient care differently than they would have handled it otherwise.

Changes to these aspects of care were reported by physicians

  • Diagnosis 29%
  • Choice of Tests 51%
  • Choice of Drugs 45%
  • Reduced Length of Hospital Stay 19%
  • Advice Given to the Patient 72%

Physicians said information provided by library contributed to their ability to avoid

  • Hospital Admission 12%
  • Patient Mortality 19%
  • Hospital-Acquired Infection 8%
  • Surgery 21%
  • Additional Tests or Procedures 49%

The physicians rated the information provided by the library more highly than that provided by other information sources such as diagnostic imaging, lab tests, and discussions with colleagues. In addition to confirming earlier research findings that information provided by hospital libraries is perceived by physicians as having a significant impact on clinical decision making, the results increase our store of scientific knowledge about the specific nature and extent of the impact of information provided by the hospital library.

Abstract: 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.

Purpose: To examine the associations between (1) the economic indicators of hospital costs, charges, and length of stay (LOS) for inpatient cases and (2) the use of MEDLINE searches for such cases. Method: An outcome-based, objective, prospective study with an economic evaluation was conducted from September 1989 to September 1990 at three metropolitan Detroit teaching hospitals representing both allopathic and osteopathic care. The study consisted of (1) 192 test cases, derived from a consecutive sample of inpatients of all ages for whom MEDLINE searches were requested at the participating medical libraries, and (2) 10,409 control cases, which were of the same diagnosis-related groups (DRGs) as the test cases but did not involve identified MEDLINE searches. Statistical analysis included the use of multivariate analyses of variance and correlation coefficients. Comparisons of cases were made on case-by-case and DRG bases regarding total patient costs, charges, and lengths of stay for cases with or without MEDLINE searches. RESULTS. The test cases were found to have a higher severity of illness. Among test cases, statistically significant relationships existed between (1) hospital expenses and LOS and (2) hospital expenses and the timing of the search during hospitalization when controlling for LOS. When cases were matched for DRG and LOS, the cases with early searches (i.e., conducted during the first half of hospitalization) had significantly lower expenses. CONCLUSION. Of the test-case patients (for whom MEDLINE searches were conducted during hospitalization), those whose searches were conducted earlier had statistically significantly lower costs, charges, and lengths of stay than those whose searches were conducted later.


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