- 医院质量联盟(Hospital Quality Alliance, HQA)的质量评价指标得分更好
- 缩短了患者住院时间(每年缩短372,000天)
- 降低了患者死亡率(三年挽救了11,500条生命)
“这些数据提示,使用计算机辅助工具如UpToDate,能够获得更好的决策、 更好的转归和更好的诊疗。”
— 作者,哈佛大学学者Ashish Jha, M.D., M.P.H.
采用临床医生搜索查询数据监测流感疫情
Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK, Oliver KB, Thompson CA, Romanosky N, Hunter S. Using clinician's search query data to monitor influenza epidemics. Clin Infect Dis. (2014) 59 (10): 1446-1450 first published online August 12, 2014 doi:10.1093/cid/ciu647.
结论: 美国临床医生在UpToDate中的搜索查询信息,可适时预测流感疫情。
研究表明,基于数据库的疾病监测工具,可能为准确预测流感暴发提供的另一种可靠并且稳定的信号。
访问在线医学信息的时间趋势
Lott JP, Roy B, Venkatesh AK (2014), Temporal trends in accessing online medical information. J. Hosp. Med., 9: 525–526. doi: 10.1002/jhm.2211.
结论: 自2004年1月以来,与UpToDate有关的搜索量稳定增加,而其他在线医学信息的搜索量出现了降低(图1)。
约2011年7月以来,与UpToDate有关的搜索量平均已超过JAMA、NEJM和PDR(图1),然而与PubMed有关的检索量仍然最多,不过也呈现降低趋势。
线性回归发现了下述显著性趋势系数:UpToDate(相关系数= 0.010),JAMA(相关系数=−0.012),NEJM(相关系数= −0.030),PDR(相关系数= −0.020),和PubMed(相关系数= −0.011)。这些系数相互之间均存在显著性差异。
图1:
在线医学信息的Google搜索趋势。按在线医学资源分别列出2004-2013年的Google搜索查询兴趣的时间趋势。缩略语:JAMA,美国医学会杂志;NEJM,新英格兰医学杂志;PDR,美国医师桌上参考手册。
临床知识随时间延长而减少
查看图表
Study: Clinical questions raised by clinicians at the point of care: a systematic review.
Authors: Del Fiol G, Workman TE, Gorman PN. Systematic review: the relationship between clinical experience and quality of health care. JAMA Intern Med. 2014 May;174(5):710-8. doi: 10.1001/jamainternmed.2014.368.
Findings: Clinicians frequently raise questions about patient care in their practice. Although they are effective at finding answers to questions they pursue, roughly half of the questions are never pursued. This picture has been fairly stable over time despite the broad availability of online evidence resources that can answer these questions. Technology-based solutions should enable clinicians to track their questions and provide just-in-time access to high-quality evidence in the context of patient care decision making. Opportunities for improvement include the recent adoption of electronic health record systems and maintenance of certification requirements.
- In 11 studies, 7012 questions were elicited through short interviews with clinicians after each patient visit.
- The mean frequency of questions raised was 0.57 (95% CI, 0.38-0.77) per patient seen, and clinicians pursued 51% (36%-66%) of questions and found answers to 78% (67%-88%) of those they pursued.
- Overall, 34% of questions concerned drug treatment, and 24% concerned potential causes of a symptom, physical finding, or diagnostic test finding.
- Clinicians' lack of time and doubt that a useful answer exists were the main barriers to information seeking.
系统综述:临床经验和诊疗质量之间的关系
Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005; 142:260.
结论: 本研究对“执业多年的医生,已积累了可让他们提供更高质量护理的知识和技能”的认知进行了研究。然而,医生执业的年数与其所提供的医疗质量之间存在负相关。作者得出结论:
- 对于执业时间更长的医生,他们存在提供更低医疗质量的风险。因此,他们需要改善医疗质量的干预措施。
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临床问题常见,但大多数并未得到解决
解答内科医生的临床问题:障碍和可能的解决方案
Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians' clinical questions: obstacles and potential solutions. J Am Med Inform Assoc. 2005 Mar-Apr;12(2):217-24.
结论: 一项针对美国爱荷华州全科医生的研究探究了内科医生解答他们的临床诊疗问题时的障碍。内科医生每半天查询5.5个问题,但仅对55%的问题寻找了答案。在这55%问题中,UpToDate是医生最常用的工具(41%),医生使用的其他工具包括:Epocrates (25%)、 MICROMEDEX (15%)和Sanford Guide to Antimicrobial Therapy(桑福德抗微生物治疗指南)(14%) 。
- 典型的初级保健医生每天大约会遇见11个问题。他们对其中55%的问题寻找了答案,但只有40%的问题得到了解决。
- 所有问题都得到解决的话,最多每天可以改变5项诊疗决策。
- 未找寻答案的最常见原因是,他们怀疑答案是否存在。
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住院医生在临床工作中的医学信息需要:这些需要得到满足吗?
Green ML, Ciampi MA, Ellis PJ. Residents' medical information needs in clinic: are they being met? Am J Med. 2000 Aug 15;109(3):218-23.
结论:
- 住院医生每接诊3名患者就会产生2个问题,其中29%的问题得到了解决。
- 问题没有得到解决的主要原因是缺乏时间(60%)。
研究:实践中的信息:家庭医生关于患者诊疗问题的分析。
作者: Ely JW, Osheroff JA, Ebell MH, Bergus GR, Levy BT, Chambliss ML, Evans ER. Analysis of questions asked by family doctors regarding patient care. BMJ. 1999 Aug 7;319(7206):358-61.
结论:
- 家庭医生常常遇到关于患者诊疗的问题(每10名患者出现约3个问题,或每天约8个问题),但仅40%的问题回去寻找答案。在这些问题中,80%的问题得到解答。
- 当问题被认为是紧急以及问题被认为存在明确的答案,医生才回去寻找答案。
研究:初级保健中的信息搜寻:内科医生如何选择哪些问题去找答案而哪些问题搁置不解答。
Authors: Gorman PN, Helfand M. Information seeking in primary care: how physicians choose which clinical questions to pursue and which to leave unanswered. Med Decis Making. 1995 Apr-Jun;15(2):113-9.
结论:
- 初级保健医生在接诊患者的时候会产生很多临床问题,但他们仅对约30%的临床问题寻找解决方案。
- 两个主要因素决定哪些问题会解决:内科医生相信存在明确的答案,以及患者问题的紧迫性。
研究:临床诊疗中的信息需求:得到满足了吗?
作者: Covell, DG, Uman, GC, Manning, PR, Information Needs in Office Practice: Are They Being Met? Ann Intern Med 1985;103(4):596-9.
结论:本研究在半天的时间内,对47位典型诊室工作医生的自我报告进行了分析。
- 医生自我报告,他们答案,平均起来每周一次。
- 医生每接诊3名患者就会出现约2个问题。
- 仅30%的临床问题得到了解答,这通常由另一位医生或其他卫生保健专业人员来解答的。
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UpToDate比其他资源更有效地回答临床问题
研究:患者诊疗中图书馆和信息服务的价值:一项多中心研究的结果
作者: Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK, Oliver KB, Thompson CA, Romanosky N, Hunter S. The value of library and information services in patient care: Results of a multi-site study. Journal of the Medical Library Association 2013 Jan; 101(1):39-46.
美国MidAtlantic地区的国立医学图书馆网络和Chapel Hill市北卡罗来纳州大学的研究人员进行了一项大型、多中心的研究。该研究对在服务118家医院的56个图书馆中心的16,122位临床医生进行了调查,意在了解图书馆和信息服务对患者诊疗的价值和影响。
结论: 受访者被要求报告最近一次搜寻患者诊疗信息的例子。研究发现:
- UpToDate是内科医生和驻院医生最常使用的CDS工具,使用频率明显多于任何其他CDS工具。
- 临床医生报告,避免了6%的患者诊疗事故中的患者死亡
- 临床决策因查阅资源而更改:诊断(25%),药物选择(33%),其他治疗(31%),处方(23%),以及患者建议(48%)。
- 临床医生报告,避免了的不良事件包括:误诊,患者死亡,药物不良反应,用药错误,和开具不必要的检查。
- 85%的受访人报告,信息可使他们每次平均节约2.5小时。
经医学图书馆协会授权使用
UpToDate和ClinicalKey的比较性试验:用户偏好调查
作者: Michael R. Kronenfeld, MLS, MBA, AHIP, R. Curtis Bay, PhD, William Coombs, MA. Survey of user preferences from a comparative trial of UpToDate and ClinicalKey. J Med Libr Assoc. 2013 April; 101(2): 151–154.
美国医学图书馆协会杂志(JMLA)近期发表了一项研究:该研究由A. T. Still卫生大学主导,旨在是肩并肩的比较UpToDate和ClinicalKey。这项调查研究由来自骨科医学院和一项内科医生协助计划的23位大学教学人员和292位大学生完成。
结论:
- UpToDate的总体满意度评分高于ClinicalKey。特别是在参与临床轮转或在临床教学的内科医生中,他们推崇UpToDate。
- UpToDate因容易使用、解答具体问题的效率、知识体系和深度而受医生强烈支持。
- 如果图书馆仅能二选一,那么更多的医生首选UpToDate。
- 受访人认为,ClinicalKey在教学方面因其的全文数据库方面而存在一定的价值,但它不足以作为床旁诊疗工具。
研究作者得出结论,UpToDate在临床情景中是首选的。他们进一步得出结论,“它不仅在临床情景中大量使用”,并且受访人报告学生如果没有UpToDate的访问权限,他们会“处于一种竞争性劣势。”
作者注意到,ClinicalKey“暗示它作为医生床旁诊疗的工具”。然而,作者认为,ClinicalKey并不足以作为医生床旁诊疗的工具。
研究:床旁利用电子信息资源UpToDate作出临床决策。
作者: Phua J, MBBS, MRCP, See KC, MBBS, MRCP, Khalizah HJ, MBChB Manc, MRCP, Low SP, MBBS, MRCP, Lim TK, MBBS, FRCPE. Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds. Singapore Med J 2012; 53(2): 116-120.
结论:
- 每次搜索需要的中位时间为3分钟(第一四分位数:2分钟;第三四分位数:5分钟)
- UpToDate导致37%的检查、诊断或治疗出现更改
- 结论:“在临床决策中,把UpToDate结合于每日床边查房中是可行的和有用的。”
研究:通过四种循证教材(ACP PIER、Essential Evidence Plus、First Consult [循证医学诊疗系统]和UpToDate)进行答案检索的比较:一项随机化对照试验。
Authors: Ahmadi SF, Faghankhani M, Javanbakht A, Akbarshahi M, Mirghorbani M, Safarnejad B, Baradaran H. Tehran University of Medical Sciences, Iran Med Teach. 2011;33(9):724-30.
结论:
- 答案检索率是:UpToDate为86%,First Consult为69%,ACP PIER为49%,Essential Evidence Plus为45% (p<0.001)。
- 在UpToDate的答案检索平均时间明显更快。
- 与其他三种循证教科书进行比较,UpToDate在内容方面显然更全面且更快速解答问题。因此,可以认为在床旁诊疗时,UpToDate是解答临床医生问题的最佳来源之一。
研究:比较PubMed Clinical Queries 和 UpToDate 在对临床住院医生的教学信息掌握方面的作用:一项交叉随机化对照试验
作者: Sayyah Ensan L, Faghankhani M, Javanbakht A, Ahmadi SF, Baradaran HR. Center for Educational Research in Medical Sciences, Medical Education and Development Center, Tehran University of Medical Sciences, Tehran, Iran PLoS One. 2011;6(8):e23487. Epub 2011 Aug 12.
结论:
- 根据意向治疗分析,受试者检索使用UpToDate检索到67个问题(76%)的答案,而使用PubMed Clinical Queries 检索到38个答案(43%) (P<0.001)。
- 采用UpToDate,答案检索的中值时间显著更快。
- 与PubMed Clinical Queries 用户进行比较,UpToDate用户对检索答案准确性的满意度和交互更高,总体满意度也更高(P<0.001)。
研究:在Google、Ovid、PubMed和UpToDate中的速度、准确性和信心:一项随机化试验的结果。
作者: Robert H Thiele, Nathan C Poiro, David C Scalzo, et al. Postgrad Med J 2010 86: 459-465 doi: 10.1136/pgmj.2010.098053
结论:
- Google是最受欢迎的搜索工具。
- Google 和 UpToDate 的用户比 PubMed 的用户,更可能获得正确的问题答案。
- 受试者对 UpToDate 的信心最大。
- 采用 Google 和 UpToDate 搜索,比采用 PubMed 或 Ovid 更快。
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研究:采用以用户为中心的任务定向方法,评价五种床旁信息产品。
作者: Campbell R, Ash J. An evaluation of five bedside information products using a user-centered, task-oriented approach. J Med Libr Assoc 2006 Oct; 94(4):435-41, e206-7.
结论:
- 与任何一种其他资源进行比较,采用 UpToDate 的受试者成功地解答了更多的临床问题(P<0.0001)。
- 在回答这个问题时-“总体上,这个数据库能满足您的需要吗”,UpToDate比所有其他资源明显排名更高(P=0.006)。在使用容易性方面,UpToDate也明显排名更高(P<0.0001)。
- 大多数用户(76%)把UpToDate列为最好的产品,同时没有任何用户把UpToDate排名为最差的产品。
研究:医学院医学职员的阅读习惯:频率、实用性和难度。
结论:Johns Hopkins的医学生中,UpToDate是最常用的阅读资源,被评定为是最有用的。
研究:临床轮转的初级保健住院医生阅读习惯的多计划评价。
作者: Lai CJ, Aagaard E, Brandenburg S, Nadkarni M, Wei HG, Baron R., Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations. J Gen Intern Med. 2006 May;21(5):486-9.
结论:98%的住院医生报告定期使用UpToDate,44%的使用文献搜索,35%的使用Google.com或其他搜索引擎。
研究:解答医生的临床问题:障碍和可能的解决方案。
作者: Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians' clinical questions: obstacles and potential solutions. J Am Med Inform Assoc. 2005 Mar-Apr;12(2):217-24.
结论: 在爱荷华州进行的一项针对全科医生研究评估了妨碍医生解答患者诊疗问题的障碍。内科医生每半天查询5.5个问题,但其中仅55%的找到了答案。在解决这些问题的过程中,医生共查阅10种信息资源;其中,UpToDate 在这些信息资源中是最常用的(41%)。其他使用的资源包括:Epocrates (25%); MICROMEDEX (15%);和Sanford Guide to Antimicrobial Therapy(桑福德抗微生物治疗指南)(14%)。
- UpToDate 比任何其他特定资源更多的用于解决问题。
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研究:医学生对信息资源的应用:数字化时代到来了?
作者: Peterson MW, Rowat J, Kreiter C, Mandel J. Medical students' use of information resources: is the digital age dawning? Acad Med. 2004 79(1):89-95.
结论: 爱荷华州大学的研究人员监测了大学二年级的学生在过渡到临床实习期间使用UpToDate的情况。大学生快速采用UpToDate。
- 85%以上的医学生将电子资源作为他们医学信息的主要来源(UpToDate 53%,MDConsult 33%)。与其他资源相比,医学生常常更喜欢UpToDate。
- 他们每天都会使用电子信息资源,并且需要不到15分钟的时间解答他们的大多数临床问题。
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UpToDate比其他电子临床资源用得更多
Psychiatry Residents’ Use of Educational Websites: A Pilot Survey Study
Authors: Torous J, Franzan J, O’Connor R, Mathew I, Keshavan M, Kitts R, Boland R. Psychiatry Residents’ Use of Educational Websites: A Pilot Survey Study. Acad Psychiatry 2015. DOI 10.1007/s40596-015-0335-8.
Findings: 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.
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研究:在线搜索医学信息:加拿大肾病学家的调查。
作者: Shariff SZ, Bejaimal SA, Sontrop JM, Iansavichus AV, Weir MA, Haynes RB, Speechley MR, Thind A, Garg AX. J Nephrol. 2011 Nov-Dec;24(6):723-32. doi: 10.5301/JN.2011.6373.
Finding: 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.
Study: Answers to Questions Posed During Daily Patient Care Are More Likely to Be Answered by UpToDate Than PubMed.
Authors: Hoogendam A, Stalenhoef AFH, de Vries Robbé PF, Overbeke AJ, Answers to Questions Posed During Daily Patient Care Are More Likely to Be Answered by UpToDate Than PubMed. J Med Internet Res 2008;10(4):e29.
Findings: 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.
Study: Evidence Based Library and Information Practice.
Authors: Farrell A, Evidence Based Library and Information Practice 2008, 3:2
Findings: 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.
Study: Randomized trial for answers to clinical questions: Evaluating a pre-appraised versus a MEDLINE search tool.
Authors: Patel MR, Schardt CM, Sanders LL, Keitz SA. Randomized trial for answers to clinical questions: evaluating a pre-appraised versus a MEDLINE search protocol. J Med Libr Assoc. 2006 Oct;94(4):382-7.
Findings: 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.
Study: An evaluation of five bedside information products using a user-centered, task-oriented approach.
Authors: Campbell R, Ash J. An evaluation of five bedside information products using a user-centered, task-oriented approach. J Med Libr Assoc 2006 Oct; 94(4):435-41, e206-7.
Findings:
- 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.
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Study: The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficulties.
Authors: Leff B, Harper GM, The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficultie. Acad Med. 2006 May;81(5):489-94.
Findings: Among medical students at Johns Hopkins, UpToDate was the most commonly used reading source and was rated as the most useful.
Study: Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations.
Authors: Lai CJ, Aagaard E, Brandenburg S, Nadkarni M, Wei HG, Baron R. Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations. J Gen Intern Med. 2006 May;21(5):486-9.
Findings: Of online sources, 98% of residents reported using UpToDate regularly, 44% used literature search, and 35% used Google.com or other search engines.
Study: Answering physicians' clinical questions: obstacles and potential solutions.
Authors: Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians' clinical questions: obstacles and potential solutions. J Am Med Inform Assoc. 2005 Mar-Apr;12(2):217-24.
Findings: 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%).
- UpToDate was used more than any other specific resource to answer pursued questions.
Study: Residents' patient-specific clinical questions: opportunities for evidence-based learning.
Authors: Schilling LM, Steiner JF, Lundahl K, Anderson RJ. Residents' patient-specific clinical questions: opportunities for evidence-based learning. Acad Med. 2005 Jan;80(1):51-6.
Findings: 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.
Study: Medical students' use of information resources: Is the digital age dawning?
Authors: Peterson MW, Rowat J, Kreiter C, Mandel J. Medical students' use of information resources: is the digital age dawning? Acad Med. 2004 79(1):89-95.
Findings: 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.
Study: Centres for Health Evidence Demonstration Project.
Authors: Stewart T, et al. Centres for Health Evidence Demonstration Project.
Findings: In a study at the University of Alberta, physicians used UpToDate more than any other electronic clinical reference including Medline, MDConsult, Harrison's Online, and over 30 others.
- Physicians used UpToDate more than any other electronic clinical reference including Medline, MDConsult, Harrison's Online, and over 30 others.
Download a PDF presented from the Canadian Association for Information Science.
UpToDate improves patient care
Study: The value of library and information services in patient care: results of a multisite study
Authors: Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK, Oliver KB, Thompson CA, Romanosky N, Hunter S. The value of library and information services in patient care: Results of a multi-site study. Journal of the Medical Library Association 2013 Jan; 101(1):39-46.
A large-scale, multi-site study on the value and impact of library and information services on patient care was conducted by the National Network of Libraries of Medicine, MidAtlantic region and researchers at the University of North Carolina at Chapel Hill. The respondents were 16,122 clinicians at 56 library sites serving 118 hospitals in urban and rural areas.
Findings: Survey respondents were asked to report on a recent incident in which they had sought information for patient care. The study found:
- UpToDate was the most used CDS tool by physicians and residents, used significantly more than any other CDS tool. Use of UpToDate followed closely behind only research studies
- Clinicians reported that patient mortality was avoided in 6% of patient care incidents
- Clinical decisions changed as the result of consulting resources: diagnoses (25%), choice of drugs (33%), other treatment (31%), ordered tests (23%) and patient advice (48%)
- Clinicians reported that adverse events were avoided including, misdiagnosis, patient mortality, adverse drug reactions, medication errors and ordering of unneeded tests
- 85% of respondents reported that the information saved them an average of 2.5 hours per incident
Used with permission from the Medical Library Association
Study: How doctors make use of online, point-of-care clinical decision support systems: a case study of UpToDate®
Authors: : Addison J, Whitcombe J, Glover SW. How doctors make use of online, point-of-care clinical decision support systems: a case study of UpToDate. Health Information & Libraries Journal, 2012 30, pp. 13–22
Through an online questionnaire, investigators surveyed doctors at healthcare organizations in North West England which subscribe to UpToDate. Respondents were asked to describe a scenario in which they had used UpToDate, and to identify benefits, if any, associated with that scenario.
Findings: More than 90% of the 239 respondents who had used UpToDate identified at least one benefit:
- 57% reported using UpToDate reduced treatment delays
- 52% reported using UpToDate meant they avoided unnecessary diagnostic tests
- 48% reported UpToDate reduced delays in diagnosis
- 39% reported UpToDate changed their treatment decision
- 28% reported UpToDate reduced the time to discharge
Study: Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States.
Authors: Bonis PA, Pickens GT, Rind DM, Foster DA. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Int J Med Inform. 2008 Nov;77(11):745-53.
The authors examined the impact of evidence-based knowledge (provided mainly from UpToDate) on attending physicians' treatment decisions about hospitalized patients.Before being provided information, most attending physicians believed that they had made an evidence-based choice. After reading the information:
Findings:
- Demonstrated strong association between hospital quality and efficiency and use of UpToDate.
- Hospitals with access to UpToDate performed significantly better on risk-adjusted measures of patient safety and complications and had significantly shorter length of stay (by an average 0.167 days per discharge) compared with hospitals without access. These benefits correlated with how frequently UpToDate was used.
Study: An evaluation of five bedside information products using a user-centered, task-oriented approach.
Authors: Campbell R, Ash J. An evaluation of five bedside information products using a user-centered, task-oriented approach. J Med Libr Assoc 2006 Oct; 94(4):435-41, e206-7.
Findings:
- 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.
Study: The impact of evidence on physicians' inpatient treatment decisions.
Authors: Lucas BP, Evans AT, Reilly BM, Khodakov YV, Perumal K, Rohr LG, Akamah JA, Alausa TM, Smith CA, Smith JP. The impact of evidence on physicians' inpatient treatment decisions. J Gen Intern Med. 2004 May;19(5 Pt 1):402-9.
The authors examined the impact of evidence-based knowledge (provided mainly from UpToDate) on attending physicians' treatment decisions about hospitalized patients.Before being provided information, most attending physicians believed that they had made an evidence-based choice. After reading the information:
Findings:
- Treatment changed in 18% of patients.
- Most changed decisions were considered to have improved the care of the patient.
Study: Usage of UpToDate at an academic medical center.
Authors: Maviglia, SM, Martin, MT, Wang, SJ, et al. Usage of UpToDate at an academic medical center. J Gen Inter Med 2002; 17(Suppl1):204.
Findings: An online survey of clinicians at the Massachusetts General Hospital and Brigham and Women's Hospital described the following effects among UpToDate users:
- 95% reported that UpToDate was integral for making decisions
- 94% reported that they had changed diagnosis
- 95% reported that UpToDate led to a change in patient management
- 97% said UpToDate helps them provide the best care for their patients
- 90% reported that UpToDate makes them a better doctor
- 96% reported made them more comfortable with their decisions
Study: Can an electronic database help busy physicians answer clinical questions?
Authors: Blackman D, Cifu A, Levinson W. Can an electronic database help busy physicians answer clinical questions? J Gen Intern med 2002; 17Suppl1:220.
Findings: 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.
UpToDate has an important role in medical education
Study: Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores.
Authors: Darcy A. Reed, MD, MPH, Colin P. West, MD, PhD, Eric S. Holmboe, MD, Andrew J. Halvorsen, MS, Rebecca S. Lipner, PhD, Carola Jacobs, BA, and Furman S. McDonald, MD, MPH. Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores. J Gen Intern Med. 2012 Feb.
Findings: Maintenance of certification (MOC) examination performance is associated with quality of care. A study at the Mayo Clinic aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine.
- Use of UpToDate was associated with improved scores on Internal Medicine Maintenance of Certification Examinations (IM-MOCE).
Click here to read the epub abstract.
Study: Resource utilization patterns of third-year medical students.
Authors: Cooper AL, Elnicki DM. Resource utilization patterns of third-year medical students. Clin Teach. 2011 Mar;8(1):43-7.
Findings: Most students used UpToDate to prepare for attending physician rounds and to admit patients (64% and 67%, respectively), but not for exam preparation.
Study: A multi-institutional survey of internal medicine residents' learning habits.
Authors: Edson RS, Beckman TJ, West CP, Aronowitz PB, Badgett RG, Feldstein DA, Henderson MC, Kolars JC, McDonald FS. A multi-institutional survey of internal medicine residents' learning habits. Med Teach. 2010;32(9):773-5.
Findings: 95% reported UpToDate was the most effective resource for learning. 90% reported that UpToDate was their first choice for answering clinical questions.
Study: How residents and interns utilize and perceive the personal digital assistant and UpToDate.
Authors: Phua J, Lim TK. How residents and interns utilize and perceive the personal digital assistant and UpToDate. BMC Medical Education 2008, 8:39. doi:10.1186/1472-6920-8-39.
Findings: A survey study at National University Hospital in Singapore found that after 5 months of use 60% of respondents reported that UpToDate lead to a change in patient management and 95% would recommend UpToDate to a colleague.
Study: Factors associated with medical knowledge acquisition during internal medicine residency.
Authors: McDonald FS, Zeger SL, Kolars JC. Factors associated with medical knowledge acquisition during internal medicine residency. J Gen Intern Med. 2007 Apr 28.
Findings: A study of internal medicine residents at the Mayo Clinic examined the impact of learning habits such as conference attendance and use of an electronic knowledge resource (UpToDate) on medical knowledge acquisition as measured by the Internal Medicine In-training Examination (IM-ITE). The IM-ITE assesses the medical knowledge of internal medicine residents during their three-year training program; scores increase with each year of residency reflecting the acquisition of medical knowledge during residency. Performance on the examination correlates with subsequent performance on the American Board of Internal Medicine Certification Examination. The authors correlated how much UpToDate was used by each resident (based upon usage logs) with IM-ITE scores. Using UpToDate for 20 minutes a day was associated with a comparable increase in IM-ITE scores as an entire year of residency. The model was fully adjusted and considered known covariates associated with performance on the IM-ITE, suggesting that use of UpToDate was an independent predictor of performance. A similar degree of benefit was also detected for regular conference attendance. The authors also cited a survey of 18,000 residents in which UpToDate was the most commonly used clinical resource for clinical information. These data (as well as previous studies involving UpToDate) suggest that it has an important role in medical education and in acquisition of medical knowledge.
- Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training.
Study: The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficulties.
Authors: Leff B, Harper GM. The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficulties. Acad Med. 2006 May;81(5):489-94.
Findings: Among medical students at Johns Hopkins, UpToDate was the most commonly used reading source and was rated as the most useful.
UpToDate use provides quantifiable ROI
Study: The Total Economic Impact of UpToDate's Clinical Decision Support System for Healthcare Institutions: A Case Study of Salford Royal NHS Foundation Trust
Authors: Forrester Consulting. A Forrester Total Economic Impact™ Study Prepared for UpToDate. November 2011.
In May 2011, Forrester Consulting examined the total economic impact and potential return on investment (ROI) UK hospitals may realize by deploying UpToDate's clinical decision support solution.
This study illustrates the financial impact of using UpToDate clinical decision support within the Salford Royal NHS Foundation Trust (SRFT), a large teaching hospital near Manchester, UK. SRFT employs more than 5,000 staff members treating some 400,000 patients annually and has subscribed to the UpToDate service for seven years.
Findings: An analysis of UpToDate use at SRFT and subsequent financial analysis found that SRFT's use of UpToDate resulted in significant improvements in the quality of care, staff productivity, and diagnostic test efficiencies. SRFT experienced quantifiable ROI, covering all the costs of the service within 90 days.
UpToDate: One-Year, Risk-Adjusted Benefits, Costs, and ROI Summary |
|||
ROI | Payback period | Total benefits | Total costs |
402% | < 3 months | £123,958 | (£24,678) |
Source: Forrester Research, Inc. |
UpToDate saves time
UpToDate Individual Subscriber Survey: 2014.
Authors: UpToDate
Findings: 89% of subscribers said UpToDate saves them time.
Study: Can an electronic database help busy physicians answer clinical questions?
Authors: Blackman D, Cifu A, Levinson W. Can an electronic database help busy physicians answer clinical questions? J Gen Intern med 2002; 17Suppl1:220.
Findings: A pilot study 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.
- UpToDate users were able to answer their questions significantly faster (p=.03), finding answers within minutes compared to up to three days for controls.