2014introducingCM1: Library Resources1

Library website, how to log in with proxy and how to log in to Google.Then how to find the CM1 page2

http://med.mercer.edu/library/CM1.htm3ObjectivesGuiding you through the big picture, data, and resources 4Big PictureIdentify some of the reasons for conducting a Community Health Needs Assessment by reviewing an example of a completed Community Health Needs Assessments in Georgia.1 In order to really appreciate the Information Needs Assessment you will be completing in CM1, we need to look at the big picture.5Organization of care. Popular folk, self-help

The Community Responsive PracticeBelief SystemsExplanatory Models

Organization of care Professional

COPE

Mettee, T.M. 1987. Community Diagnosis: A Tool for COPC. Community Oriented Primary Care: From Principle to Practice. P.A. Nutting (Ed). U.S. Department of Health and Human Services, Public Health Service, Health Resources and Services Administration Publication Number HRS-APE 86-1, Washington, D.C. pp.52-58. (7 pages)

You have discussed with Dr. Deveroux the Mette article. Can anyone explain this Venn diagram?

In the article METTE was explaining how different areas of medicine come together to help improve the community response. It is more than just having the best standards, it is also understanding the culture, belief systems, etc.

6

So you start off thinking you have this great idea, and its going to bring about world peace7Idea

The idea is rolling through your mind and8

IdeaIts so great its going its like lighting a fire9

IdeaIt will change everyone's mind/behavior10Idea

Childhood ObesityIt will drastically reduce any negative health outcome, like childhood obesity11Idea

And the idea will continue to grow in the community12

Sprouting new lifestyle changes.13CommunityData

But here is the catch. It is easy to market or plant the seed, the hard part is getting it to stick or grow. In order to do this you have to understand your community. For instance, if you were planting a banana tree, you wouldnt plant it in Greeneland! 14COUNTYDATARESOURCESSTATENATIONALCommunityDataYou need to have an understanding of your community demographics, and other areas to make sure the effort spent on an idea will catch on.

15

Evaluate ResourcesToo much information?

Divide and conquer your needs assessment.

We will help you navigate statistics on sites to find the accurate information.This is the needs assessment, while it looks like a lot of information this information is necessary to get an accurate picture of your community. For instance, even if you know your community has an issue with obesity do you know if it is caused by poor diet or lack of exercise? If it is lack of exercise then do they have limited access to parks, or is there high crime rate, or is it a need for education. It is important to understand the entire picture in order to effect change in a community.16

http://www.uwce.org/our-work/community-indicators/

This is the Community Indicators page for Chatham County. The Savannah area is fortunate that a coalition started pulling all of the data together to get an overall picture of the community. So lets take a look at their data. 17

http://www.uwce.org/our-work/community-indicators/

This is just one of the screen shots to show the students. It shows several different indicators that are then compared to other U.S. Counties. It is beneficial as it shows the county information and then compares it to other areas. 18

https://www.nghs.com/fullpanel/uploads/files/1-ngmc-final-report--2smlr.pdf

Another County that is fortunate to have a well documented Needs Assessment is Hall County in northeast Georgia.On you primary reading list it had this pdf document pages 1-7. Please take a moment to skim these pages.

Did you notice anything that stuck out to you? What about the resources they used to gather this data? Where you familiar with any of these resources? Did you see why these CHNA are being done by so many counties? 19

https://www.nghs.com/fullpanel/uploads/files/1-ngmc-final-report--2smlr.pdf

If you look closely here on the Executive Summary, it tells you that these needs assessments are being done to fulfill a requirement by the IRS. 20

TheAffordable Care Act (ACA), enacted March 23, 2010, added new requirements that hospital organizations must satisfy in order to be described in section 501(c)(3), as well as new reporting and excise taxes.Yes as part of the new Affordable Care Act, all hospitals that are 501(3) are now required to complete a CHNA in the area their hospital serves. What do you think about this? Do you think it is helpful to the communities?

Do you think looking at this data is helpful to changing health behaviors?

Now youve kind of seen a brief report on how the data available can be evaluated to improve the communitys health.

Think about it, hospitals collect tons of data from EHR, or from paper. The issue is there is no one consistent system that this information is entered into. Yes many hospitals now enter most items into an EHR, but there is no one standard EHR and the terms used can even vary. This is one issue the Affordable Healthcare Act is looking to rectify, but it is still a work in progress. So when communities start pulling data together, it may be hard to extract the data (or find it), it may be difficult to compare it back to the national or state level as people use different terms, etc. You also have to be careful not to compare aggregate data to 1 years worth of data. To make sure you are comparing the same type of data.

So what about evaluating the data that is available? Is all information available online correct? 21EvaluatingResourcesDemonstrate the ability to evaluate resources, particularly online resources, for accuracy, authority, objectivity, currency, and coverage2 22Resources

AccuracyAuthorityObjectivityCurrencyCoverage

Evaluation of Resources:Part of good info literacy is making decisions about the usefulness of the info youve found. These are some criteria by which you can evaluate resources. Today were talking about statistical resources on the web, but really you can apply these to any info resources you use.23

AccuracyWhere did the data come from?Methods or Sources sectionIs it consistent with other resources (if any)?Are terms and measures defined?Compare apples to apples

[animation is automatic]Accuracy: how sure are you that the data is true and real? How was it collected? Do they tell you? (Methodology section) [example from County Health Rankings]If you have multiple data sources (it happens), how well do they agree?If they dont agree, check to see if theyre using the same definitions for terms and measures24Accuracy: example

EXAMPLE: Americas Health RankingsIn their about section they go into great detail about not just their data sources but also how they choose among different sources, the weighting and statistical manipulation of their data to reach numerical scores, etc. Sections of the page not shown here include Selection, Weighting, Definition of Measures, etc.25

AuthoritySourceswhose information?Primary data source or aggregator of others data?Editor lists, editorial statementsMethodology disclosure helps boost confidence here tooFor research articles, case studies etc.:Peer reviewAuthor affiliation statements

[animation is automatic]Whos responsible for the information? What are their qualifications for putting it out there?Look again for methodology, often youll also find list of names of the editorial boardthese are the folks who bear ultimate responsibility, whose reputation is on the line.26Authority: example

EXAMPLE: County Health RankingsSite is undersigned by a laundry list of foundations and individuals-Robert Wood Johnson Foundation-University of Wisconsin Population Health Institute-Community Catalyst-11 individual leaders on 5 different teams -5 data partnersEtc.27ObjectivityEverybody has an anglewhat is it?Can you distinguish between regular and sponsored content?

[animation is mostly automatic]Basically, what is the sources motivation for providing this information? Many have a mandate to be objective, but not allsome are selling product, or selling you as an advertising target. Not always easy to determine whats straight info and whats advertising either; were not always as smart as we think we are.EXAMPLE: WebMDThis site sells advertising to stay in business. Its upfront and honest about whats sponsored content, but its also very subtle about it. Here are 2 WebMD pages about triglycerides, one straight from their articles and one an advertisement. Can you find where it admits to being an ad?[CLICK TO SHOW ARROWS] Not exactly in your face about it.28

CurrencyHow recent is your data?May be impossible to get very recent data (less than 2-3 years)Collection, compilation, etc. can take a long timeSome resources present data from a mix of datescheck details, FAQsIf historical data is available, look for trends

[animation is automatic]Statistical data collection & processing is not a speedy process; may take years to whip into publishable shape.Thats if the data is collected at all. Not just a slow process but a costly one; there may not be funding for re-doing a survey that was last done 7 years ago.If you find historical data but not more current (or data with missing points) you may be able to interpolate/extrapolate trends but thats approximate at best, dont trust conditions not to have changed.29Currency: example

EXAMPLE: NCES literacy statistics estimates of low literacyThis is data itd be really nice to have for a variety of reasons. Too bad the most recent info available dates back to 2003. (Space shuttle Columbia blew up; no-one had heard of Napoleon Dynamite; Mr. Rogers was still alive)

30

CoverageGeographical coverage:Extent (does it cover the area in question)Granularity (in small enough chunks: state, county, etc.)Subject coverage:Extent (covers the topic in question)Granularity (divisions between groups: percentages, quartiles, arbitrary groups)[animation is automatic]This is basically: do you really have the information you want? Is it giving it to you in usable form?If youre looking for county-level info and the source only goes to state level, thats not going to be very helpful (granularity). Or if you want info for all of the US and it only gives you the SE region, ditto (extent).Subject coverage: if you want info for 18-24yos and the site breaks ages down as 0-17, 18-34, 35-50 etcIf the info is more finely divided than you want, you can sometimes work with itharder to finesse if its less finely divided.31Coverage: example

EXAMPLE: CDC info on childhood obesity trendsThis is misleading. You see they cite their source, Pediatric Nutrition Surveillance System 2008-11That source really monitored only low-income children in federally funded health programs. Extrapolating to talk about general population is a real stretch.32

Its not just about data, but quality data strengtheningYOUR IDEA.33 3GROUP WORKParticipants in groups will share with the class key databases used to locate articles, disease information, and county, state and national statistics. 34GroupsThink, Pair, Share.Review your site by yourself 5 minutesReview your site with someone next to you5 minutesGroups present5 minutes

Review website for: AccuracyAuthorityObjectivityCurrencyCoverage

Group 1:City-datahttp://www.city-data.com/

Group 2: AHRQ ePSShttp://epss.ahrq.gov/PDA/index.jsp 35 4Stats WebsitesIdentify and demonstrate effective use of county, state and national data sources (i.e., vital statistics, epidemiological and demographical) that a physician needs to describe and assess (diagnose) the health status of a community. While it may be easy to evaluate a website to determine the reliability of the source, it can be challenging just to locate the data. So knowing this, lets take a look at some of the statistical websites.

An important understanding when searching for statistics is recognizing the limitations to what data is available and from what years. Lets say you want to look at Georgia county data of adult smokers who died in 2013 from lung cancer across all races.

While you will certainly find many aspects of this information need, not all specifications will be available. For instance the most recent years data is not always possible to get. Additionally, you will have to seek out several sources to compile the data (there isnt a nice one-stop shop website for everything youll need) and by doing so you need to ensure the data types and data sources are cross-referenceable. 36Stats ResourcesAmerican Community SurveyAmericas Health RankingsAAMC (Association of American Medical Colleges)Centers for Disease Control and PreventionCounty Health RankingsGeorgia Bureau of InvestigationGeorgia Department of Public HealthGeorgia Department of Labor Georgia Labor Market ExplorerGeorgia Statistics SystemKaiser Family FoundationKids Count Data CenterNational Center for Educational StatisticsOASIS (Online Analytical Statistical System)Together We Can Do BetterU.S. CensusU.S. Census: American Fact FinderU.S. Census: Quick Facts

These are the resources that we listed on the secondary resources. Of course, we will not have time to review every single one of these reasons (sigh of relief). We will go into the main resources needed for you to complete your CHNA. This means we will just review county level resources, and not go into as many national resources. So County Health Rankings and OASIS will allow you to compare county level health data, whereas the CDC, will allow you to compare national data.37

http://www.census.gov/

Census.gov provides comprehensive demographic as well as other types of information, many available at the county level. Data here is mostly 2010 but make sure for the date and source because you can find newer and older information (Census 2000 data for instance).

Scroll to the links at the bottom of the homepage to get to American FactFinder.38

http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml

If you go into American Fact Finder, start by finding your county. We will look at Bibb or Chatham County today.

There is more than simple population and demographic statistics available. Note the variety of broad categories to choose from on the left.

Well start with Population. Go to the General Population and Housing Characteristics table. Here youll see a varied breakdown of population stats. Raw numbers and percents are given.

Now lets look at another category. Click on Community Facts to go back to your options page.

Select Education this time. Go to the first link, Educational Attainment. The first thing to pay attention to is where the figures are coming from. Unlike the 2010 Census population table we saw earlier this comes from the 2008-2012 American Community Survey 5-Year Estimates. 39

The Georgia Statistical System is a service of the Department of Agricultural and Applied Economics, the Cooperative Extension Service, and the Carl Vinson Institute of Government, University of Georgia.

It contains a wide variety of statistical data available at the county level.

A good place to start is the County-by-county analysis. There are 3 search steps you *must* make before the data will be provided.

Step 1) Select all Georgia or a specific county(ies).

Step 2) Choose one or up to four variable to display at once. For today, lets look at the main category of Public Assistance. Food Stamps, TANF. There are several specific variables to look at here. Lets select TANF, Monthly Avg Families, FY2011 and TANF, Monthly Avg Recipients, % of Pop, FY2011

Step 3) Select the analysis type. Click See the Data and then Go to Query.

To view sources and appendices go back to the Cross Sectional Analysis homepage. From this page you can also access the

You can also access County Guide data from previous years on this page. See the top of the page. County Health Rankings

The Online Analytical Statistical Information System is the best way to access the Georgia Department of Public Healths data, including vital stats.

Data can be filtered down by county, age, race, ethnicity, rate, cause, and more.

Today well look at how to gather Mortality statistics.

Mortality Measure Deaths & Death Rate; North Central Health District (Macon); Stroke under Major Cardiovascular Disease. Click Get Data to view.

You can make changes to your search from the data result page. If youre not sure what something means, there is a Definitions button right above Get Data on the upper right.

The OASIS home button is on the far left side of the screen. .

Now lets look at the dashboards. Here you will find aggregate data from 2007 through 2011 for causes of death. At the top of the page you will be able to filter by county, age, race and various rates.

Visit the Community Health Needs Assessment Dashboard to find ranked causes of death by county, age, race and rate. It gives raw numbers as well as Be aware that this will give *aggregate* data on the top 10 Causes of Death by selected age groups, Last 5 Year Aggregated together.

Scroll down to view age category rankings.

Click on a category to learn more information, including trends.

County Health Rankings is a collaboration between theRobert Wood Johnson Foundation and theUniversity of Wisconsin Population Health Institute It is quite easy to use. You can compare counties within a state according to various categories and rankings, including health outcomes, health behaviors, demographics, clinical care, social & economic factors.

Right from the front homepage, the link to the data and methods used is right there.

Click GA. From the map view here you can compare rankings between counties by selecting the type of ranking or measure desired.

But if youre simply looking for data about a particular county, the easiest method is to drill down to the county profile page.

Go to Bibb or Chatham and view county snapshot data. Then click to Additional Measures. Scroll down for Uninsured Children. From here show the Data Source.

We already saw the large database of data and statistics the Georgia Department of Public Health. However you can find more information on their website. Additionally if youre ever looking for county or region level statistics that you cant find via OASIS you may want to contact the GDPH. Often they collect more raw data, or data broken down by additional categories, than what they present either via OASIS or their website.

Just show the website and give a brief overview.

Go here for crime statistics. Remember some figures related to criminal behaviors and activity can be found elsewhere.

Explain the labor market for Georgia is where you can find information for specific employment types but it is not easy to navigate. You can go to Search local employers

And then look at the area profile

Again another great resource. It is a great place to for students and residents find exam and match related statistics. It is also the home of the State Physician Workforce data books.

http://kff.org/The Henry J. Kaiser Family Foundation compiles different data including information on medicare beneficiaries

So you can see that there are lots of resources available online that supply statistics, but how does this help you? Well, lets do another group project. 5GROUP WORKParticipants in groups will share with the class key databases used to locate articles, disease information, and county, state and national statistics. 51GroupsThink, Pair, Share.Review at least one field in your CHNA workbook and find the number(s) needed 5 minutesReview your result(s) with someone next to you5 minutesGroups present5 minutes

Mortality rate for your Needs Assessment ProjectLets work a little on your CHNA. Then come back together as a group and give a report.52 6RESEARCHINGAt the Library

Identify key databases, which include PubMed and other library resources, to find articles, and disease information. Once you have found all the statistics, you will eventually need to find trials and other data to back up your plan of action. Or you may be asked by a clinician to look up the latest published information on a specific topic. Where would you go to get this information? Yes Google Scholar is great, and we can go into that at another time, but right now we are going to look at PubMed which will help make navigating the scientific literature a little easier. 53Searching PubMed at Mercer

How many of you have heard of PubMed? For those of you who might not know, and as a reminder to those of you who have heard of PubMed, PubMed is a resource that currently contains over 22 million citations and abstracts from national and international health, medical, biomedical, and chemical science journals. These citations are input into the MEDLINE database, which is one of several databases PubMed utilizes.

While PubMed is a free resource maintained at the National Library of Medicine, and you can get to it by searching for PubMed in any browser, we strongly recommend accessing the PubMed link from the Medical Librarys homepage. The reason is because the National Library of Medicine has assigned the medical library a special URL to flag the journals we pay for. So when you log in from the Medical Library website, Your Mercer pw + our link = more full text articles!

To access PubMed from the library site, you will first need to visit the librarys site at http://med.mercer.edu/lib/Then from the homepage, click the Databases & Resources dropdown. Youll see all the librarys resources listed here alphabetically, so go down and select PubMed@MUSM to search the PubMed with the Medical Librarys content.

54

Wed like to preface this part of presentation by mentioning that PubMed is a complex resource and there are hour- and day-long training sessions dedicated to learning the advanced features of PubMed. Since we only have a short time with you, this is going to be a VERY brief crash course on PubMed. And as always, if you want to do some more exploring on your own and find you have questions, dont hesitate to get in touch with the library. We are available to help you via phone, email, or drop-ins.

This is the PubMed home screen. Theres a lot going on here, but were going to focus up at the search bar and do a basic search. Lets search for: asthma AND influenza Feel free and follow along. With us.55SYPHILIS ORPREGNANCY=

asthma AND influenzaasthma OR influenzaBoolean Termsasthmainfluenza

asthmainfluenzaBefore we show discuss our PubMed search results, wed like to mention Boolean Operators or Boolean Terms.

The operators And Or and Not can transform your search results without having to utilize advances features. These arent unique to PubMed; Boolean Terms are utilized in all databases and search interfaces (Google search, etc.)

In this slide, you can see that when you pair asthma and influence with the And operator, your results are more limited because you are only looking to retrieve citations where both these terms are included. Accordingly, when you pair asthma and influenza with the Or operator, you are telling the search interface that you want citations that have either one of these terms, which obviously yields more results.56

So here is what happens in PubMed when you search for asthma AND influenza.

By default, PubMed shows 20 citations per page sorted by when they were input into the MEDLINE database. Results at the top are generally more recent and have not yet been indexed by the MEDLINE/PubMed staff. Youll notice that article citations populate the center of the page, while on the left side, you have Filter options.

Some of the more popular filters include limiting by publication dates (specific ranges, the past 5 years, etc.), languages (dozens of different languages), article type (systematic reviews, randomized control trials, case reports, etc.), and ages (varying levels of children and adults, including infants, teens, elderly, etc.).

Wed like to call attention to the Text Available filter. The Free Full Text available option will only retrieve results for articles freely available to everyone. Since you are logging into PubMed through the MUSM library site, you have access to far more than free-to-the-world full-text items. So please use discretion when using the Free Full Text filter. 57

Beyond the default PubMed view, you can choose to view article entire article abstracts rather than just citations. Do this by clicking on the Display Settings arrow and selecting Abstract under the Summary heading. Accordingly, you can also select to show more or less results at once, and you can also sort your results by various options too.

Here we see our top result from the journal Vaccine. You can see the additional abstract information below the citation, and then down at the bottom, you can see icons. Icons will differ from publication to publication, but if logging in through the PubMed@MUSM option from the librarys homepage dropdown menu, you will ALWAYS see this Get it @ MUSM icon. We recommend clicking the Get it @ MUSM icon first as that will link you to all the library-subscribed content. Selecting the publisher icon may take you to a page that will ask you to login on the publishers page. When accessing library content, the only time you will be asked to login is through the Medical Library login page; you never need to login on a publisher's site.

If the library has a subscription to the journal, after click the Get it @ MUSM you will see links to where you can download a PDF of the article. While the library has thousands of journal subscriptions, we dont own everything. But, if theres something we dont own, after click the Get it @ MUSM icon, you will have the option to submit the request directly to us. In that case, we will borrow the article for you on interlibrary loan from another library. ILL requests are usually filled within 3-5 days so keep this in mind. Your access will not be instant so if you are doing last-minute research, the library might not be able to deliver ILL to you in time.58 ?Questions

Class review is next! 59

Library Resources!

Community Medicine 160