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First published August 23, 2006 as JAMIA PrePrint; doi:10.1197/jamia.M2158
Journal of the American Medical Informatics Association 2006;13(6):593-600
© 2006 American Medical Informatics Association

A more recent version of this article appeared on November 1, 2006
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Submitted on May 23, 2006
Accepted on August 8, 2006

McMaster PLUS: A cluster randomized clinical trial of an intervention to accelerate clinical use of evidence-based information from digital libraries

R. Brian Haynes MD, PhD, MSc1*, Jennifer Holland MLIS1, Chris Cotoi MBA, MEng1, R. James McKinlay MSc1, Nancy L. Wilczynski MSc1, Leslie A. Walters BA1, Dawn Jedraszewski1, Rick Parrish1, K. Ann McKibbon MLIS, PhD1, Amit X. Garg MD, PhD2, and Stephen D. Walter PhD3

Affiliation of the authors: 1 Health Information Research Unit, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada ; 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology, University of Western Ontario, London, Ontario, Canada ; 3 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

* To whom correspondence should be addressed.

Background Physicians have difficulty keeping up with new evidence from medical research.

Methods We developed the McMaster Premium LiteratUre Service (PLUS), an internet-based addition to an existing digital library, which delivered quality- and relevance-rated medical literature to physicians, matched to their clinical disciplines. We evaluated PLUS in a cluster-randomized trial of 203 participating physicians in Northern Ontario, comparing a Full-Serve version (that included alerts to new articles and a cumulative database of alerts) with a Self-Serve version (that included a passive guide to evidence-based literature). Utilization of the service was the primary trial endpoint.

Results Mean logins to the library rose by 0.77 logins/month/user (95% CI 0.43, 1.11) in the Full-Serve group compared with the Self-Serve group. The proportion of Full-Serve participants who utilized the service during each month of the study period showed a sustained increase during the intervention period, with a relative increase of 57% (95% CI 12, 123) compared with the Self-Serve group. There were no differences in these proportions during the baseline period, and following the crossover of the Self-Serve group to Full-Serve, the Self-Serve group's usage became indistinguishable from that of the Full-Serve group (relative difference 4.4 (95% CI -23.7, 43.0). Also during the intervention and crossover periods, measures of self-reported usefulness did not show a difference between the 2 groups.

Conclusion A quality- and relevance-rated online literature service increased the utilization of evidence-based information from a digital library by practicing physicians.




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