UpToDate is the Only Clinical Decision Support Resource Associated with Improved Outcomes

Over the years UpToDate® has been the subject of over 30 research studies confirming that 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

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

Click here to read more.

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Clinical knowledge declines over time

Study: Systematic review: the relationship between clinical experience and quality of health care.

Authors: Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005; 142:260.

Findings: 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.

Fletcher Abstract PDF.

Study: Changes over time in the knowledge base of practicing internists.

Authors: Ramsey PG, Carline JD, Inui TS, Larson EB, LoGerfo JP, Norcini JJ, Wenrich MD. Changes over time in the knowledge base of practicing internists. JAMA. 1991 Aug 28;266(8):1103-7.

Findings: Knowledge of internists sharply declined within 15 years of certification.

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Clinical questions are common but most are not answered

Study: UpToDate Individual Subscriber Survey: 2012.

Authors: UpToDate

Findings: 91% of subscribers said they are able to find answers to most of their clinical questions in UpToDate.

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%).

  • 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.

Ely Abstract PDF.

Study: Residents' medical information needs in clinic: are they being met?

Authors: 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.

Findings:

  • Residents identified 2 questions for every 3 patients they saw and pursued answers to 29% of the questions.
  • The primary reason for not pursuing answers was lack of time (60%).

Click here to read more.

Study: Information in practice: analysis of questions asked by family doctors regarding patient care.

Author: 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.

Findings:

  • Family doctors frequently had questions about patient care (about 3 questions per 10 patients or 8 questions per day) but pursued answers to only 40 percent of them. Of those pursued, 80% were answered.
  • An answer was pursued when the problem was perceived as urgent and when a definitive answer was thought to exist.

Click here to read more.

Study: Information seeking in primary care: how physicians choose which clinical questions to pursue and which to leave unanswered.

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.

Findings:

  • Primary care physicians have many clinical questions while they are seeing patients, but they pursue only about 30% of their questions.
  • Two primary factors determined which questions were pursued: the physician's belief that a definitive answer existed, and the urgency of the patient's problem.

Click here to read more.

Study: Information needs in office practice: are they being met?

Authors: Covell, DG, Uman, GC, Manning, PR, Information Needs in Office Practice: Are They Being Met? Ann Intern Med 1985;103(4):596-9.

Findings: 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.

Covell Abstract PDF.

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UpToDate answers clinical questions more effectively than other resources

Survey of user preferences from a comparative trial of UpToDate and ClinicalKey

Authors: 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.

The Journal of the Medical Library Association (JMLA) recently published, and released to the general public, a study conducted by the A. T. Still University of Health on a side-by-side comparison of UpToDate and ClinicalKey. The survey study was completed by 23 faculty members and 292 students from two osteopathic schools of medicine and a physician assistant program.

Findings:

  • UpToDate scored higher than ClinicalKey on overall satisfaction, particularly by those in clinical rotation or teaching in the clinic who strongly preferred UpToDate.
  • UpToDate was strongly favored for ease of use, efficiency in answering specific questions, organization and depth.
  • UpToDate was the preferred choice by a large margin if the library could only purchase one product.
  • Respondents reported that Clinical key was valued for its library of full texts by those in the didactic or classroom phase of training, but that its use as a point-of-care tool was limited.

Study authors conclude that UpToDate was preferred in the clinical setting. They further concluded that “not only was it heavily used in the clinical setting,” but that respondents reported students “were at a competitive disadvantage if they did not have access to it.”

The authors noted that ClinicalKey, in advance marketing “implied its use as a point-of-care product for physicians.” However, the authors conclude that ClinicalKey’s “use as a point-of-care product was limited by the fact that the survey respondents did not find First Consult, which represents the major point-of-care content in ClinicalKey, to be at all comparable to UpToDate.”

Click here to read more.

Study: Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds.

Authors: 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.

Findings:

  • Each search took a median of three minutes (first quartile: two minutes, third quartile: five minutes).
  • UpToDate led to a change in investigations, diagnosis or management 37% of the time
  • Conclusion: "Incorporating UpToDate searches into daily bedside rounds was feasible and useful in clinical decision-making."

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Study: A comparison of answer retrieval through four evidence-based textbooks (ACP PIER, Essential Evidence Plus, First Consult, and UpToDate): A randomized controlled trial.

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.

Findings:

  • The rate of answer retrieval was 86% in UpToDate, 69% in First Consult, 49% in ACP PIER, and 45% in Essential Evidence Plus (p<0.001).
  • The mean time to answer retrieval was significantly faster with UpToDate.
  • UpToDate seems more comprehensive in content and also faster than the other three evidence-based textbooks. Thus, it may be considered as one of the best sources for answering clinicians' questions at the point of care.

Click here to read more.

Study: To Compare PubMed Clinical Queries and UpToDate in Teaching Information Mastery to Clinical Residents: A Crossover Randomized Controlled Trial

Authors: 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.

Findings:

  • Based on intention-to-treat analysis, participants retrieved the answer of 67 (76%) questions using UpToDate and 38 (43%) questions using PubMed Clinical Queries (P<0.001).
  • The median time to answer retrieval was significantly faster with UpToDate.
  • The satisfaction with the accuracy of retrieved answers, interaction with UpToDate and also overall satisfaction were higher among UpToDate users compared to PubMed Clinical Queries users (P<0.001).

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Study: Speed, accuracy, and confidence in Google, Ovid, PubMed, and UpToDate: results of a randomised trial.

Authors: Robert H Thiele, Nathan C Poiro, David C Scalzo, et al. Postgrad Med J 2010 86: 459-465 doi: 10.1136/pgmj.2010.098053

Findings:

  • Google was the most popular search tool.
  • Users of Google and UpToDate were more likely than users of PubMed to answer questions correctly.
  • Subjects had the most confidence in UpToDate.
  • Searches with Google and UpToDate were faster than searches with PubMed or Ovid.

Click here to read the PDF.

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 clini cal 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.

Campbell Abstract PDF.

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.

Click here to read more.

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.

Click here to read more.

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 questions. 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.

Ely Abstract PDF.

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.

Peterson Abstract PDF.

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 were collected on 678 patient visits over 5 weeks.

  • Physicians who had access to UpToDate used it as their main resource for getting answers.
  • They used UpToDate 50% of the time, turned to textbooks 14% of the time, performed online literature searches 13% of the time and relied on colleagues 7% of the time.
  • The percentage of questions answered by interviewed physicians was 34.3% versus 18.7% for controls (P=0.07).

Blackman Abstract PDF.

Study: Clinician use of UpToDate: CareGroup online survey 2002.

Authors: Halamka J, MD, MS, CIO, CareGroup Health Systems.

Findings: CareGroup, a large integrated healthcare network comprised of six hospitals in the greater Boston area, conducted a survey to evaluate clinician use of UpToDate.

  • UpToDate was used heavily.
  • UpToDate was the most popular internet resource being used by physicians and it was used frequently: 45% of clinicians used UpToDate more than 5 times per week.

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.

Download a PDF presented from the Canadian Association for Information Science.

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UpToDate is used more than other electronic clinical resources

Study: UpToDate Individual Subscriber Survey: 2012.

Authors: UpToDate

Findings: 83% of clinician subscribers said UpToDate is integral to their practice.

Study: Searching for medical information online: a survey of Canadian nephrologists.

Authors: Shariff SZ, Bejaimal SA, Sontrop JM, Iansavichus AV, Weir MA, Haynes RB, Speechley MR, Thind A, Garg AX.

Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario - Canada and Division of Nephrology, University of Western Ontario, London, Ontario - Canada.

Abstract:

Background: Physicians often search for information to improve patient care. We evaluated how nephrologists use online information sources for this purpose. Methods: In this cross-sectional study (2008 to 2010), a random sample of Canadian nephrologists completed a survey of their online search practices. We queried respondents on their searching preferences, practices and use of 9 online information sources. Results: Respondents (n=115; 75% response rate) comprised both academic (59%) and community-based (41%) nephrologists. Respondents were an average of 48 years old and were in practice for an average of 15 years. 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. Conclusions: Nephrologists routinely use a variety of online resources to search for information for patient care. These include bibliographic databases, general search engines and specialized medical resources.

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.

Click here to read more.

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.

Click here to read more.

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.

Click here to read more.

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.

Campbell Abstract PDF.

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.

Click here to read more.

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.

Click here to read more.

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.

Ely Abstract PDF.

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.

Schilling Abstract PDF.

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.

Peterson Abstract PDF.

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.

Study: Clinician use of UpToDate: CareGroup online survey 2002.

Authors: Halamka J, MD, MS, CIO, CareGroup Health Systems.

Findings: CareGroup, a large integrated healthcare network comprised of six hospitals in the greater Boston area, conducted a survey to evaluate clinician use of UpToDate. The survey found:

  • UpToDate was used heavily.
  • UpToDate was the most popular internet resource being used by physicians and it was used frequently: 45% of clinicians used UpToDate more than 5 times per week.

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UpToDate saves time

Study: UpToDate Individual Subscriber Survey: 2012.

Authors: UpToDate

Findings: 87% of subscribers said UpToDate saves them time.

Study: Can an electronic database help busy physicians answer cli nical 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.

Blackman Abstract PDF.

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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

Click here to read more.

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

Click here to read more.

Study: UpToDate Individual Subscriber Survey: 2012.

Authors: UpToDate

Findings:

  • 93% of subscribers said UpToDate improves the quality of care they provide to their patients.
  • 90% of subscribers said UpToDate has led to more efficient patient management.
  • 88% of subscribers said UpToDate has led to more appropriate diagnostic testing.

Study: UpToDate Enterprise Subscriber Survey: 2010 - 2011

Authors: UpToDate

Findings:

  • 98% said UpToDate improves the care they provide.
  • 95% said UpToDate makes care more efficient.
  • 93% said UpToDate is important for patient safety.
  • 98% strongly agreed that having access to UpToDate within their institution is important.
  • 83% strongly agreed that having access to UpToDate at home is important.
  • 93% strongly agreed that having access to UpToDate at their clinic is important.

Surveys were executed at more than 1,300 U.S. and Canadian enterprise accounts from May 10, 2010 - August 26, 2011. 80,750 end users at these accounts completed a survey during this time period.

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.

Solucient Study Abstract PDF.

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.

Campbell Abstract PDF.

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 imp roved the care of the patient.

Click here to read more.

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

Atlanta Abstracts PDF.

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.

Blackman Abstract PDF.

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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.

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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.

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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.

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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.

McDonald Abstract PDF.

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.

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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 a patient-specific clinical question affected residents' patient care decisions. Internal medicine residents were asked to formulate a clinical question and use evidence-based learning guidelines to answer. Results from the study show that:

  • 78% of answers changed patient care.

Schilling Abstract PDF.

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.
  • Students used electronic information resources daily and required less than 15 minutes to answer most of their clinical questions.

Peterson Abstract PDF.

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