UpToDate Plays Strategic Role in Improving Quality of Care at Kanta-Häme Central Hospital

Introduction

As part of the Kanta-Häme Hospital District, the Kanta-Häme Central Hospital (KHCH) is an acute care 338-bed hospital providing patient-centered, specialized medical care through its two facilities in Hämeenlinna and Riihimäki, in the south of Finland. The Hämeenlinna unit serves the entire hospital district of 173,800 inhabitants, while the Riihimäki unit primarily serves municipalities in the region, as well as the Janakkala area, for a total of 62,400 inhabitants. Combined, these two facilities employ 140 full-time clinicians and 850 full-time nurses.

The hospital is tasked with a mission to serve as the central, go-to hospital for area residents where they can be confident they will receive comprehensive, high quality care. KHCH espouses two core values: responsibility and competitiveness. The central hospital feels a deep responsibility to provide the best care for patients throughout the continuum of care. KHCH strives to operate a welcoming and well-run facility that supports a positive, integrated patient experience, while ensuring cost-effective care with measurable outcomes.

Assessing the need for UpToDate

Interest in UpToDate was initially generated by two clinicians who had individual subscriptions funded by the hospital. Based on their feedback, and on the experience of other Finnish healthcare institutions already using the resource, the hospital decided to run a trial of UpToDate, asking all physicians to test it in their daily use.

While clinicians already had access to a local database of evidence-based guidelines in Finnish, the hospital clinical management was looking for a more comprehensive resource that would support clinicians when they needed to research conditions that were less common and about which they had less knowledge or experience. The results from the trial period confirmed UpToDate was a much needed resource to ensure patients were receiving high quality care, and the clinical decision support resource was officially adopted by Kanta-Häme Central Hospital in March of 2010. One of the deciding factors that led clinicians to adopt UpToDate during the trial was the depth and breadth of its content. With clinical topics spanning 16 specialties (which has grown to 25 specialties in 2017), UpToDate enabled clinicians to investigate unusual and often rare cases, something that set it apart from the local resource, which focused on a smaller group of more common diseases.

Kari Mikkonen

"The main reason for purchasing UpToDate was the breadth of content. With UpToDate, physicians also get information and recommendations on rare cases where they don't have as much experience."

— Kari Mikkonen, Kanta-Häme Central Hospital, Information Specialist

"The main reason for purchasing UpToDate was the breadth of the content. With UpToDate, physicians also get information and recommendations on rare cases where they don’t have as much experience," said Kari Mikkonen, Kanta-Häme Central Hospital Information Specialist.

Dr. Jaalama

"From UpToDate, I find clinical manifestation for different syndromes or genetic problems which are quite rare…It is impossible to know every rare disease, but with good information sources, it is possible to find answers to clinical questions and benefit from the evidence and experts’ knowledge."

— Marian Jaalama, MD, Medical Specialist in Gynecology and Obstetrics, Kanta-Häme Central Hospital

Dr. Marian Jaalama, a Medical Specialist in Gynecology and Obstetrics at KHCH, added, "In my daily practice I … do ultrasound examinations for pregnant women. From UpToDate, I find clinical manifestation for different syndromes or genetic problems which are quite rare. I can also find out how to follow up on those symptoms and learn what kind of problems can appear during the pregnancy. It is impossible to know every rare disease, but with good information sources, it is possible to find answers to clinical questions and benefit from the evidence and experts’ knowledge."

Comparative survey confirms adoption of UpToDate and move to UpToDate Anywhere

In December 2016, Kari Mikkonen conducted a survey of clinicians to gather feedback about UpToDate as they neared the sixth anniversary of having UpToDate at the hospital. The survey assessed UpToDate Anywhere, which the hospital upgraded to in April 2016 in order to provide access to UpToDate on mobile devices within and outside the hospital. At the time, the hospital also had access to a similar resource via Terveysportti, the Finnish Health Portal.

Comparative Usage

The survey targeted KHCH clinicians and compared UpToDate and the other resource. For a period of two weeks in December 2016, 6 questions were asked, covering the following areas:

1. Currentness of the service

2. Coverage of the service

3. Usability of the service

"The results were absolutely overwhelming and they were all pro-UpToDate (figure 1). The main feedback from the clinicians was that UpToDate is an easy-to-use resource which gives access to high quality, relevant information to back up their decision making," explained Kari Mikkonen.

Dr. Jaalama commented, "I think that UpToDate is easier to use and the information is analyzed very well. The search engine is easy to use for us too, even though we aren’t speaking English as our mother language. It is very fast to find answers from UpToDate’s index and articles. I think that UpToDate is a very user-friendly information source."

Lauri Suojanen, MD

"…It is really a joy to read most of the time, compared to some bullet point guidelines… One of the most important things is that UpToDate also provides the opinion of the writers. In addition to the guideline/treatment recommendation itself, it is very useful to hear what the personal, experienced opinion of an expert is."

— Lauri Suojanen, MD, Resident in Internal Medicine, Kanta-Häme Central Hospital

Dr. Lauri Suojanen, a Resident in Internal Medicine at KHCH discussed the value of the in-depth content in UpToDate, "As a doctor in specialist training, I use UpToDate very much for studying interesting and important topics in internal medicine. It is very useful and important that UpToDate isn’t just bullet points, but instead a written article. The pathophysiology of different disease states is often very accurately described. It is really a joy to read most of the time, compared to some bullet point guidelines. The references are easy to show too. One of the most important things is that UpToDate also provides the opinion of the writers. In addition to the guideline/treatment recommendation itself, it is very useful to hear what the personal, experienced opinion of an expert is."

Mikkonen concluded, "Based on the facts that I know and the feedback I’ve been getting, UpToDate is a quick way to find relevant and reliable information to base clinical decisions on. And quick is the keyword here, because of the hectic environment clinicians operate in."

A commitment to UpToDate Anywhere

While clinician usage of UpToDate had grown gradually over the years, the strong adoption of UpToDate Anywhere boosted usage to over 5,400 topics viewed in 2016. This represented a 68% jump compared to 2015 (figure 2). At the same time, KHCH was facing increased financial pressures incurred from paying for an alternative service in Terveysportti in addition to UpToDate. UpToDate’s very high usage, coupled with positive feedback about UpToDate in survey results, helped to build a compelling argument to continue subscribing to UpToDate.

UpToDate Usage

The next step in the adoption of UpToDate at Kanta-Häme Central Hospital will be the embedding of the clinical decision support resource into its patient information system, Effica.

UpToDate Supports Kanta-Hame Central Hospital's Strategy

UpToDate supports Kanta-Häme Central Hospital’s overall strategy as an organization in the following areas:

1. Competetiveness

In the Finnish healthcare landscape, patients are increasingly making decisions about which health organization to use based on the quality of care provided. UpToDate provides a competitive advantage over other institutions by attracting more patients.

2. Cost Efficiency

UpToDate is designed to be used at the point of care. Clinicians can quickly find answers to their clinical questions without having to perform extensive research in resources like PubMed, thus improving their time with patients and their overall productivity.

"There are economic savings if we know how to treat patients instead of sending them to university hospitals. Of course better healthcare helps reduce illnesses overall and that is balancing cost and quality," said Dr. Jaalama.

3. Clinical Effectiveness

Kanta-Häme Central Hospital is the central hospital in the Hämeenlinna region and as such, it is responsible for providing the most current medical knowledge to healthcare providers and high quality care to patients in the area. UpToDate helps KHCH achieve that objective by ensuring clinical effectiveness.

Dr. Suojanen explained, "UpToDate provides accurate information that is easy to use and which deepens your knowledge of the subject of interest. It is both academically educating and clinically useful. I would recommend it to any doctor or hospital."

"We think that having UpToDate is a win-win-win situation," summarizes Seppo Ranta, MD, PhD., Medical Director for the Hospital District of Kanta-Häme. “It’s a win for the patients, who get better care thanks to the clinical staff having access to the latest relevant information. It’s a win for clinicians and nurses, because they can rely on a trustworthy resource in their daily decision-making. And, ultimately, it’s a win for hospital management, who can see an improvement in the quality of care we provide as well as in overall patient satisfaction."

Seppo Ranta, MD, PhD

"We think that having UpToDate is a win-win-win situation. It’s a win for the patients, who get better care thanks to the clinical staf having access to the latest relevant information. It’s a win for clinicians and nurses, because they can rely on a trustworthy resource in their daily decision-making. And, ultimately, it’s a win for hospital management, who can see an improvement in the quality of care we provide as well as in overall patient satisfaction."

— Seppo Ranta, MD, PhD., Medical Director, Hospital District of Kanta-Häme

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