I do a lot of PubMed searches for patrons, at least one or two a day on average. It is my bread and butter, after all, and I have a demanding clientele. I assume that many fellow librarians out there are doing the same. So I must say I am surprised at how little discussion there is about search strategies in the health library blogosphere. Did I miss the killer PubMed webinar that settled all questions once and for all? Am I the only librarian who harbours lingering doubts about the quality of my searches on complex subjects? Why this peculiar silence? Are we concerned about the critical eye of our peers and therefore prefer to shower in our underwear, so to speak? Do we fret that we don't fully understand the probabilistic content similarity algorithm underlying PubMed's related article search; that we haven't read every last word of the help pages and memorized all the search tags; that we can't easily explain the difference between sensitivity and specificity (quick, in 25 words or less); that we're not always sending a RefShare link with our results; or that our search string is not as big as our rival's?
Or more likely perhaps, are we simply unspeakably bored with PubMed? The pervasiveness, the profuseness of it. It has all the glamour and prolixity of a C++ manual. How can you be mindful of its programming marvels when you are yawning your way through your 69th search on catheter insertion points? Are you really that excited about filter preferences in My NCBI? If you are at lunch with a colleague and raise the issue of fuzzy sets on Boolean lattices, does she suddenly drop her pita and say, "Excuse me, my leg has gone to sleep. Do you mind if I join it?"
Granted: PubMed is as necessary as shoes, and usually worn as hard, redolent with the odour of Heideggerian Zuhandenheit. Like the philosopher's Birkenstock, it is ready-to-hand, a taken-for-granted household item. What was a near miracle just a few years ago now suffers a coolness deficit, especially when most of us would rather go on —
The Task
At the risk of causing excess NCBI (narcoleptic coma benevolently induced) in my readers, I wanted to devote this post to a discussion of one PubMed search strategy. I was recently given the task of setting up a PubMed automated update on a number of topics related to health care quality and the patient experience of health care (English articles only). Hospital managers in my neck of the woods are finally discovering the power of periodic email updates on topics that interest them. Would that I could convince them to subscribe to RSS feeds. But, frankly, it would be easier to explain the theory of relativity or go back to photocopying tables of contents. All I have to say about RSS is that, as far as my patrons are concerned, I started out with nothing and I still have most of it left. They thrive in an email ecosystem, and one must adapt or risk utter exclusion. Yet I live in hope.
The patron who consulted me had a broad interest in a number of topics:- patient satisfaction
- patient, family, consumer involvement
- patient safety
- health care quality
In addition to a PubMed search on the broad topics, it seemed expedient to add a TOC aspect by including a search for the contents of the best journals in the field of health care quality. I thus ended up with three PubMed searches, which would be combined for one weekly update:
- Tables of contents of nine major health quality journals.
- Results of a comprehensive search on the broad topics of interest: patient satisfaction, consumer and patient involvement in care, patient safety, quality in general.
- To make up for some deficiencies in PubMed's indexing of articles in the areas of interest, I included a roundup of quality-related citations from the ten most important medical and health management journals —
1. Major journals on quality
Journals of note were suggested to me by a colleague, by lists I found on the web, and a search of the NLM catalogue for currently published titles. After more consultation these were the nine titles preferred by my patron:
- Am J Med Qual
- Healthcare Benchmarks Qual Improv
- Int J Health Care Qual Assur Inc Leadersh Health Serv
- Int J Qual Health Care
- Jt Comm J Qual Patient Saf
- J Healthc Qual
- J Nurs Care Qual
- Qual Manag Health Care
- Qual Saf Health Care
2. MeSH and text string search
Medical Errors[MAJR] OR Consumer Participation[MAJR] OR Patient Satisfaction[MAJR] OR "patient safety"[TW] OR "public involvement"[TW] OR "consumer involvement"[TW] OR "consumer directed"[TW]
3. Other journal title searches + MeSH search
A search of the following ten journals was performed and ANDed with the following MeSH term: Quality of Health Care[MAJR]. Some articles of importance in these journals might not be caught by strategies 1 and 2. The heading Quality of Health Care by itself is too broad to be of use for this patron. But combined with the following journals, it will gather a few useful articles that would otherwise be missed.
"Big Five" Medical Journals- BMJ
- JAMA
- Lancet
- NEJM
- CMAJ (for Canadian articles)
.........................................................
Health Care Management JournalsFive source journals related to health care management were selected for analysis, based on the findings of a recent article in JMLA:
Health services policy research journals:
- Health Affairs (Millwood)
- Health Services Research
- Medical Care Research and Review
Practitioner-related research journals:
- Health Care Management Review
- Journal of Healthcare Management
Final Search Methodology
#1 "Qual Manag Health Care"[Journal:__jrid2514] OR "Qual Saf Health Care"[Journal:__jrid27051] OR "Am J Med Qual"[Journal:__jrid2239] OR "Healthcare Benchmarks Qual Improv"[Journal:__jrid29857] OR "Int J Health Care Qual Assur Inc Leadersh Health Serv"[Journal:__jrid21292] OR "Jt Comm J Qual Patient Saf"[Journal:__jrid32349] OR "Int J Qual Health Care"[Journal:__jrid20209] OR "J Healthc Qual"[Journal:__jrid1993] OR "J Nurs Care Qual"[Journal:__jrid1231]
#2 Medical Errors[MAJR] OR Consumer Participation[MAJR] OR Patient Satisfaction[MAJR] OR "patient safety"[TW] OR "public involvement"[TW] OR "consumer involvement"[TW] OR "consumer directed"[TW]
#3 ("Health Aff (Millwood)"[Journal:__jrid4064] OR "Health Serv Res"[Journal:__jrid3988] OR "Med Care Res Rev"[Journal:__jrid20809] OR "Health Care Manage Rev"[Journal:__jrid3962] OR "J Healthc Manag"[Journal:__jrid21284] OR "BMJ"[Journal:__jrid2274] OR "CMAJ"[Journal:__jrid20656] OR "JAMA"[Journal:__jrid5346] OR "Lancet"[Journal:__jrid5470] OR "N Engl J Med"[Journal:__jrid5985]) AND Quality of Health Care[MAJR])
#4 #1 OR #2 OR #3
#5 #1 OR #2 OR #3 Limits: English
I set up a weekly updated My NCBI email alert for the patron and hovered a bit until I knew she had verified her email address. A week later the results started rolling in and the document delivery requests started too. Another happy customer.Web Links
The Ontario Health Quality Council has a handy list of web links. I looked around a bit more, tweaked the list a bit, and sent it to my patron. I also informed her about del.icio.us and how it might be useful in her work. There will be more on that score later, but this is a decent beginning.
National
| Canada Health Infoway http://www.infoway-inforoute.ca/ |
| Canadian Council on Health Services Accreditation (CCHSA) http://www.cchsa.ca |
| Canadian Institute for Health Information http://www.cihi.ca |
| Canadian Patient Safety Institute http://www.patientsafetyinstitute.ca |
| Evaluation Society of Canada http://www.evaluationcanada.ca |
| Health Council of Canada http://www.healthcouncilcanada.ca |
| Institute for Safe Medication Practices http://www.ismp-canada.org |
| Quality Healthcare Network http://www.qualityhealthcarenetwork.ca |
| Safer Healthcare Now! http://www.saferhealthcarenow.ca |
| Statistics Canada http://www.statcan.ca |
Ontario
| Cancer Quality Council of Ontario http://www.cancercare.on.ca/index_qualityCouncil.htm |
| Change Foundation http://www.changefoundation.com/ |
| Guideline Advisory Committee http://www.gacguidelines.ca |
| HealthyOntario.com http://www.healthyontario.com/Home.htm |
| Hospital Report Research Collaborative http://www.hospitalreport.ca |
| Institute for Clinical Evaluative Studies http://www.ices.on.ca |
| Ontario Hospital Association Patient Safety Support Service http://www.oha.com/client/oha/oha_lp4w_lnd_webstation.nsf/page/Patient+Safety+Support+Service |
Other Canadian provinces
| Health Quality Council of Alberta http://www.hqca.ca |
| Health Quality Council (Saskatchewan) http://www.hqc.sk.ca |
| Western Health Improvement Network http://www.whin.org |
Manitoba Institute for Patient Safety
http://www.mbips.ca/index.html
International
| The International Society for Quality in Health Care http://www.isqua.org/ |
| Agency for Healthcare Policy and Research http://www.ahcpr.gov |
| Agency for Healthcare Research and Quality http://www.ahrq.gov |
| Balanced Scorecard Collaborative http://www.bscol.com |
| Joint Commission on Accreditation of Healthcare Organizations http://www.jointcommission.org/ |
| Institute for Healthcare Improvement http://www.ihi.org |
| NHS National Patient Safety Agency http://www.npsa.nhs.uk |
| National Quality Forum (US) http://www.qualityforum.org |
| National Patient Safety Foundation http://www.npsf.org |
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