UpToDate is the Only Clinical Decision Support Resource Associated with Improved Outcomes
Over the years, more than 80 research studies have demonstrated that the widespread usage of UpToDate is associated with improved patient care and hospital performance.
In 2011, researchers at Harvard University published a compelling study confirming that the use of UpToDate over a three year period was associated with:
- Improved quality of every condition on the Hospital Quality Alliance Metrics
- Shorter lengths of stay (372,000 hospital days saved per year)
- Lower mortality rates (saving 11,500 lives per three year period)
- “The data suggests the use of computerized tools such as UpToDate enable better decisions, better outcomes and better care.” — Ashish Jha, M.D., M.P.H., Harvard, and Study Author
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Systematic review: the relationship between clinical experience and quality of health care.
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.
Information needs in office practice: are they being met?
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.
Variable Quality and Readability of Patient-Oriented Websites on Colorectal Cancer Screening
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.
Effectiveness of a clinical knowledge support system for reducing diagnostic errors in outpatient care in Japan: A retrospective study
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.
Knowledge seeking behaviors of pre interns and early career doctors in Sri Lanka: a cross sectional study.
- UpToDate is one of the most frequently used online resources to obtain general medical information.
- Early career doctors prefer UpToDate.
The Total Economic Impact of UpToDate – A Case Study Based on The Experience of a Public and a Private Hospital in Brazil.
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
Can an electronic database help busy physicians answer clinical questions?
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.
Residents’ patient-specific clinical questions: opportunities for evidence-based learning.
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 study at the Department of Medicine at Duke University Medical Center concluded that medical libraries need to provide both MEDLINE and pre-appraised resources such as UpToDate for answers to the largest proportion of clinical questions.
Evidence-Based Library and Information Practice
A survey study at the Memorial University of Newfoundland, Canada, found that UpToDate was able to provide information for the greatest number of clinical questions compared with other evidence-based information tools evaluated.
- UpToDate was rated easy to use and informative.
Answers to Questions Posed During Daily Patient Care Are More Likely to Be Answered by UpToDate Than PubMed.
An observational study from the Netherlands evaluated 2986 patient-related questions asked by 70 physicians. Available information resources included PubMed, UpToDate, Harrison’s Online and a drug database. The authors concluded that “Based on our data, there is no reason to start searching on a lower level of the evidence-based pyramid for any major medical topic but it is sensible to use UpToDate as the primary information resource.”
- UpToDate was used most often (78% of questions), and questions were significantly more likely to be answered by UpToDate than PubMed regardless of the topic of the search.
Searching for medical information online: a survey of Canadian nephrologists.
In this cross-sectional study (2008 to 2010), a random sample of Canadian nephrologists completed a survey of their online search practices. Respondents were queried on their searching preferences, practices, and use of 9 online information sources.
- Nephrologists used a variety of online sources to retrieve information on patient treatment including UpToDate (92%), PubMed (89%), Google (76%) and Ovid MEDLINE (55%).
- Community-based nephrologists were more likely to consult UpToDate first (91%), while academic nephrologists were divided between UpToDate (58%) and PubMed (41%).
- When searching bibliographic resources such as PubMed, 80% of nephrologists scan a maximum of 40 citations (the equivalent of 2 search pages in PubMed). Searching practices did not differ by age, sex or years in practice.
Psychiatry Residents’ Use of Educational Websites: A Pilot Survey Study
Results indicate that psychiatry residents at the study site rely more on online educational resources than traditional printed resources such as textbooks. Residents reported using online resources in nearly all aspects of training, ranging from reading at home to working in the emergency department, inpatient unit, outpatient clinic, and consult service. UpToDate, PubMed, and Wikipedia were the three most utilized resources by residents and reflect the varied nature of the resources available to residents today.
UpToDate, a secondary source, was the most utilized resource, and residents gave it the highest rating for trustworthiness of recommendations. PubMed, a primary source, received the highest rating as source of personal learning but a lower ranking as a source of clinical decision-making in comparison to UpToDate.
Temporal trends in accessing online medical information
Since January 2004, relative search interest associated with UpToDate has increased steadily, whereas web-based queries for other sources of online medical information have declined (Figure 1).
Relative search interest in UpToDate has, on average, exceeded that of JAMA, NEJM, and PDR since approximately July 2011 (Figure 1), whereas PubMed has been associated with the greatest, albeit diminishing, relative search interest.
Linear regression yielded the following significant (P < 0.001) coefficients of trend for UpToDate (coefficient = 0.010), JAMA (coefficient = −0.012), NEJM (coefficient = −0.030), PDR (coefficient = −0.020), and PubMed (coefficient = −0.011). Every coefficient differed significantly from each other (P < 0.001).
Google Search trends for online medical information. Temporal trends in relative Google search query interest by online medical resource, 2004 to 2013. Abbreviations: JAMA, Journal of the American Medical Association; NEJM, New England Journal of Medicine; PDR, Physicians’ Desk Reference.
Using Clinician’s Search Query Data to Monitor Influenza Epidemics
Search query information from a clinician’s database, UpToDate, is shown to timely predict influenza epidemics in the United States.
Study results show that digital disease surveillance tools based on experts’ databases may be able to provide an alternative, reliable, and stable signal for accurate predictions of flu outbreaks.
Medical students’ use of information resources: Is the digital age dawning?
Investigators at the University of Iowa monitored the use of UpToDate by second year students as they transitioned to their clinical years. Students rapidly adopted UpToDate. By the end of their third year:
- More than 85% of medical students identified electronic sources as their primary resource for medical information (UpToDate 53%, MDConsult 33%). UpToDate was preferred significantly more often than other resources.
- They used electronic information resources daily and required less than 15 minutes to answer most of their clinical questions.
Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations.
Of online sources, 98% of residents reported using UpToDate regularly, 44% used literature search, and 35% used Google.com or other search engines.
The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficulties.
Among medical students at Johns Hopkins, UpToDate was the most commonly used reading source and was rated as the most useful.
An evaluation of five bedside information products using a user-centered, task-oriented approach.
- Participants successfully answered more clinical questions with UpToDate than with any of the other resource (P < 0.0001).
- In response to the question, “Overall, did this database satisfy your needs?,” UpToDate ranked significantly higher than all other resources (P = 0.006). UpToDate also ranked significantly higher on ease of use (P < 0.0001).
- Most users (76%) ranked UpToDate to be the best product while none rated it the worst.
Answering physicians’ clinical questions: obstacles and potential solutions.
A study of generalist physicians in Iowa investigated the obstacles preventing physicians from answering their patient care questions. Physicians asked 5.5 questions per half-day but pursued answers to just 55% of them. Of the 55% of questions pursued, UpToDate was used the most (41%) out of over 10 information resources consulted during the study. Other resources on the list included Epocrates (25%), MICROMEDEX (15%), and the Sanford Guide to Antimicrobial Therapy (14%).
- The typical primary care physician has approximately 11 questions a day. While they pursue answers to 55% of questions, only 40% get answered.
- Answering all questions would change up to 5 management decisions per day.
- The most common reason for not pursuing an answer was that they doubted that an answer existed.
UpToDate improves clinical knowledge among health care workers in Africa
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
An analysis of UpToDate usage logs among recipients of donated subscriptions in resource-limited settings between 2013 and 2014 (including 45 institutional subscriptions and 405 individual users). Approximately 150,000 unique sessions were logged, and regular (at least weekly) usage was observed among 61 percent of recipients. Users in Africa represented 54 percent of the total usage but comprised 41 percent of the donation recipient pool. Search patterns reflected local epidemiology; the top search in Africa was “Clinical manifestations of malaria,” while the top search in Asia was “Management of hepatitis B.”
UpToDate has an important role for medical education in resource-limited settings
An observational study evaluating the impact of UpToDate on medical education among 547 trainees at the University of Rwanda. Senior students viewed 1.24 topics per day (on average) and continued to use UpToDate frequently after medical school graduation. In addition, graduating class exam performance was better after introduction of UpToDate than in previous years. At baseline, 92 percent of students reported ownership of an internet-capable device, and the majority indicated frequent use of free online resources for medical education.