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Research ArticleMethodology

Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians

Pierre Pluye, Roland M. Grad, Janique Johnson-Lafleur, Vera Granikov, Michael Shulha, Bernard Marlow and Ivan Luiz Marques Ricarte
The Annals of Family Medicine November 2013, 11 (6) 559-567; DOI: https://doi.org/10.1370/afm.1565
Pierre Pluye
1Department of Family Medicine, McGill University, Montreal, Quebec, Canada
MD, PhD
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  • For correspondence: pierre.pluye@mcgill.ca
Roland M. Grad
1Department of Family Medicine, McGill University, Montreal, Quebec, Canada
MD, MSc
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Janique Johnson-Lafleur
2Information Technology Primary Care Research Group (ITPCRG), Montreal, Quebec, Canada
MSc
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Vera Granikov
2Information Technology Primary Care Research Group (ITPCRG), Montreal, Quebec, Canada
MLIS
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Michael Shulha
2Information Technology Primary Care Research Group (ITPCRG), Montreal, Quebec, Canada
MLIS
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Bernard Marlow
3College of Family Physicians of Canada, Mississauga, Ontario, Canada
MD
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Ivan Luiz Marques Ricarte
4Faculdade de Engenharia Elétrica e de Computação, Universidade Estadual de Campinas, Campinas, Brasil
PhD
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Article Figures & Data

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  • Figure 1
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    Figure 1

    Mixed methods convergence design.

    IAM=Information Assessment Method.

  • Figure 2
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    Figure 2

    The 2007 Information Assessment Method (IAM) questionnaire.

  • Figure 3
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    Figure 3

    Mixed methods data collection: flow diagram.

    IAM=Information Assessment Method.

  • Figure 4
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    Figure 4

    Physician perceptions of patient outcomes.

    Note: This diagram and corresponding vignettes are available at iamclinicalvignettes.mcgill.ca.

Tables

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    Table 1

    Avoidance of a Medical Test Associated With Found Information: A Clinical Vignette

    MD08S03: Celiac disease
    Bottom line: Information on celiac disease was used to justify the management of the patient (no testing), and it contributed to avoid an unnecessary diagnostic procedure.
    Acquisition: On May 30, 2008 [quantitative data], MD08 did a search at work, with a patient, and during the encounter [qualitative data]. They retrieved one information hit about celiac disease: The reported search objectives were: to address a clinical question and to share the information with the patient [quantitative data]. “[I was] looking up the utility of doing the test in someone who did not have symptoms; […] a first degree relative [of the patient] had been diagnosed with celiac disease; […] [the patient] was asking some questions for herself, as to whether some of her symptoms from her gastrointestinal tract could have been caused by this [disease] […] and she was asking me about doing the testing. […] She was pretty much asymptomatic, but she had this family member, and she wanted to know whether she could have the same problem.[…]It wasn’t very clear whether people who had the specific test […], transaminase antibody, whether just having the positive antibody, without symptoms, whether those people would be considered a false positive, whether it really meant anything. […] She [the patient] had a question about it. I mean she was sharing information with me and I think was asking for my feedback” [qualitative data]. According to MD08, Essential Evidence Plus (EE+) was the only source of information, and the found information was relevant [qualitative data].
    Cognition: One hit was associated with a report of highly positive cognitive impact (practice improvement) [quantitative data]. “I learned something about the sort of nuances interpreting these antibody results, […] knowing when to use it [the test] and also how to interpret the result. I think that was the [practice] improvement part of it” [qualitative data].
    Retrieved information hit(s):
    EBMG clinical topics: Celiac Disease (MD08S03H01) [quantitative data]
    Application: Information on celiac disease was used for a patient [quantitative data] to justify their management (information used as presented in EE+) [qualitative data]. “It was basically to discuss the significance of her having a positive result, but not having symptoms; […] Just because you have a positive test doesn’t mean that you have the disease. That’s the message that I gave her.”
    Patient outcomes: Regarding patient health, the information contributed to avoid an unnecessary diagnostic procedure. “[The information had an impact] in terms of not having to go into further testing” [qualitative data].

Additional Files

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  • The Article in Brief

    Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians

    Pierre Pluye , and colleagues

    Background Electronic resources help physicians find answers to clinical questions, but the wealth of information available to guide primary care practice is not used to its full potential. In this study, researchers describe a new concept about the impact of information gleaned from electronic knowledge resources.

    What This Study Found The "number needed to benefit from information" (NNBI) suggests how frequently patients may benefit when their physicians search for information in electronic knowledge resources. The NNBI will vary depending on the type of electronic resource and the clinician's characteristics, such as information seeking skills, knowledge, and behavior in specific clinical situations.

    Implications

    • This construct might be useful in experimental research to compare resources, identify kinds of clinical questions difficult to answer, and measure benefits of specific searches for information.
  • Supplemental Appendixes 1-3

    Supplemental Appendix 1. Definitions and Examples of Concepts and Technical Terms; Supplemental Appendix 2. Methods; Supplemental Appendix 3. Fifty-three Clinical Vignettes on Patient Health Benefits Associated With Physicians? Use of Information From an Electronic Knowledge Resource

    Files in this Data Supplement:

    • Supplemental data: Appendix 1 - PDF file, 3 pages, 195 KB
    • Supplemental data: Appendix 2 - PDF file, 3 pags, 194 KB
    • Supplemental data: Appendix 3 - PDF file, 3 pages, 222 KB
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The Annals of Family Medicine: 11 (6)
The Annals of Family Medicine: 11 (6)
Vol. 11, Issue 6
November/December 2013
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Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians
Pierre Pluye, Roland M. Grad, Janique Johnson-Lafleur, Vera Granikov, Michael Shulha, Bernard Marlow, Ivan Luiz Marques Ricarte
The Annals of Family Medicine Nov 2013, 11 (6) 559-567; DOI: 10.1370/afm.1565

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Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians
Pierre Pluye, Roland M. Grad, Janique Johnson-Lafleur, Vera Granikov, Michael Shulha, Bernard Marlow, Ivan Luiz Marques Ricarte
The Annals of Family Medicine Nov 2013, 11 (6) 559-567; DOI: 10.1370/afm.1565
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Subjects

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    • Mixed methods
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    • Health informatics
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Keywords

  • electronic knowledge resources
  • family physicians
  • information assessment method
  • information management
  • information storage and retrieval
  • mixed methods research
  • number needed to benefit from information
  • patient-centered care
  • patient health outcomes

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