UpToDate

The study examined the belief that physicians with more years in practice have accumulated knowledge and skills that permit them to deliver higher-quality care. However, there was an inverse relationship between the number of years that a physician had been in practice and the quality of care that they provided. The authors concluded that:

• Physicians who have been in practice longer may be at risk for providing lower-quality care. As a result, they may need quality improvement interventions.

The study examined the self-reported needs of 47 physicians during a half day of typical office practice.

• Physicians self-report that they need answers, on average, once per week.
• Physicians have about 2 questions for every 3 patients seen.
• Only 30% of clinical questions were answered, usually by another physician or other health care professional.

The efficacy of colorectal cancer (CRC) screening is dependent on participation and subsequent adherence to surveillance. The internet is increasingly used for health information and important to support decision-making. We evaluated the accuracy, quality, and readability of online information on CRC screening and surveillance.

Twenty websites were included. The mean Website Accuracy Score was 26 out of 44 (range 9-41). Websites with the highest scores were www.cancer.org, www.bowelcanceraustralia.org and www.uptodate.com.

There is marked variation in quality and readability of websites on CRC screening. Most websites do not address polyp surveillance. The poor correlation between quality and Google ranking suggests that screenees will miss out on high-quality websites using standard search strategies.

To evaluate the effectiveness of UpToDate for reducing diagnostic errors, the study authors retrospectively identified 100 patients who visited an outpatient department in a community-based hospital from July 2014 to June 2015. Half the patients were seen by physicians equipped with UpToDate and half were seen by physicians without UpToDate access. They compared diagnostic error rates between the two groups.

• The diagnostic error rate for the patients seen by physicians equipped with UpToDate was 2%.
• The diagnostic error rate for patients seen by physicians not equipped with UpToDate was 24%.
• Multivariate logistic regression analysis showed that error rate reduction was significantly associated with exposure to UpToDate with an odds ratio of 15.21 (95% CI 1.86–124.36).
• The results demonstrated the effectiveness of UpToDate for the prevention and reduction of diagnostic error.

• UpToDate is one of the most frequently used online resources to obtain general medical information.
• Early career doctors prefer UpToDate.

To evaluate the potential financial impact of UpToDate on organizations, Forrester interviewed representatives from a public and a private (nonprofit) hospital in Brazil, both with multiple years of experience using UpToDate.

The analysis was based on a hospital in Brazil with 500 beds, approximately 4,000 employees (including 800 physicians), with 24,000 admissions, 570,000 outpatient visits per year and an annual budget of approximately R$800 million.

UpToDate Has Potential to Improve the Quality of Care While Reducing Costs

All interviewed physicians felt that the widespread use of UpToDate improved the quality of care. They noted several potential impact areas, including physician productivity gains, avoidance of unnecessary referrals, reduced length of stay, avoidance of unnecessary diagnostic tests, and increased physician satisfaction.

Conservatively estimating the impact of physician productivity gains and avoidance of unnecessary referrals for a composite hospital, Forrester’s analysis points to quantifiable benefits of R$1.1 million versus total costs of R$270,000, adding up to a net present value (NPV) of approximately R$816,000 over the three years of the analysis

A pilot controlled trial of the impact of UpToDate was conducted at the University of Chicago among 10 physicians in four primary care clinics. Physicians were randomly assigned to use their usual information resources with or without UpToDate. Clinic sessions were monitored by an investigator and data was collected on 678 patient visits over 5 weeks.

• Among physicians who had access to UpToDate, 89% of questions were answered; 78% of answers changed patient care. UpToDate users answered 79% more of their questions than did physicians who did not have access and 75% more of these answers led to a change in clinical decision making.

A study at the University of Colorado examined how answering patient-specific clinical questions affected residents’ patient care decisions. Internal medicine residents were asked to formulate a clinical question and use evidence-based learning guidelines to answer them. Results from the study show that:

• UpToDate was the most frequently used information source by residents.

Randomized trial for answers to clinical questions: Evaluating a pre-appraised versus a MEDLINE search tool.

A descriptive study of UpToDate use at four hospitals in Africa – two in Rwanda (Rwinkwavu District Hospital and Kirehe Hospital), one in Malawi (Neno District Hospital), and one in South Africa (McCord Hospital). More than 100 health care workers (HCWs) received training in UpToDate use and were surveyed over a six-month study period. A broad variety of medical topics were searched. About 78 percent of HCWs reported daily or weekly UpToDate use, and 70 percent felt the tool was very useful for teaching. All users reported that the tool increased their clinical knowledge.

Potential barriers to UpToDate use in resource-limited settings are not insurmountable