Friday, December 09, 2011

Decision Support That Seems To Really Make A Difference. Australia Should Subscribe!

The following appeared just a few days ago.
November 16, 2011, 4:14 PM ET

A Little Electronic Help for Doctors Helps Hospitals, Study Shows

Hospitals that use a computerized medical-information tool to help doctors make decisions at the point of care have better patient outcomes than those who don’t, according to a new study in the Journal of Hospital Medicine.
Researchers at Harvard University examined data for Medicare beneficiaries at 1,017 hospitals between 2004 and 2006 as the hospitals adopted a clinical-information system called, UptoDate. They compared that with data from 2,305 hospitals that don’t use the system and found that use of the system was an independent predictor of reduced mortality, shorter hospital length of stay, and better performance on widely used hospital quality metrics.
The study was funded by UpToDate, but the researchers say it had no role in the study design or results.
Lead author Thomas Isaac, a physician at Beth Israel Deaconess Medical Center in Boston and instructor at Harvard Medical School, says that the researchers weren’t sure they’d find any association between the information system and the three quality measures. But hospitals saved approximately 372,500 hospital days per year and 11,500 lives over the three-year period, the study found. The hospitals using the system had better quality performance for care provided to heart-attack, heart-failure and pneumonia patients.
More here:
Here is the abstract:

Use of UpToDate and outcomes in US hospitals

  1. Thomas Isaac MD, MBA, MPH1,
  2. Jie Zheng PhD2,
  3. Ashish Jha MD, MPH2,3,4,*,§

Abstract

BACKGROUND:

Computerized clinical knowledge management systems hold enormous potential for improving quality and efficiency. However, their impact on clinical practice is not well known.

OBJECTIVE:

To examine the impact of UpToDate on outcomes of care.

DESIGN:

Retrospective study.

SETTING:

National sample of US inpatient hospitals.

PATIENTS:

Fee-for-service Medicare beneficiaries.

INTERVENTION:

Adoption of UpToDate in US hospitals.

MEASUREMENT:

Risk-adjusted lengths of stay, mortality rates, and quality performance.

RESULTS:

We found that patients admitted to hospitals using UpToDate had shorter lengths of stay than patients admitted to non-UpToDate hospitals overall (5.6 days vs 5.7 days; P < 0.001) and among 6 prespecified conditions (range, −0.1 to −0.3 days; P < 0.001 for each). Further, patients admitted to UpToDate hospitals had lower risk-adjusted mortality rate for 3 of the 6 conditions (range, −0.1% to −0.6% mortality reduction; P < 0.05). Finally, hospitals with UpToDate had better quality performance for every condition on the Hospital Quality Alliance metrics. In subgroup analyses, we found that it was the smaller hospitals and the non-teaching hospitals where the benefits of the UpToDate seemed most pronounced, compared to the larger, teaching institutions where the benefits of UpToDate seemed small or nonexistent.

CONCLUSIONS:

We found a very small but consistent association between use of UpToDate and reduced length of stay, lower risk-adjusted mortality rates, and better quality performance, at least in the smaller, non-teaching institutions. These findings may suggest that computerized tools such as UpToDate could be helpful in improving care. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.
The abstract with access options for full text is here:
You can get an idea of what UpToDate does from the 2 minute demo.
Individual subscriptions are only about $500 per annum. It does not take more than one or two improved decisions a day to make this service worth its weight in gold!
The real world study that shows it really works in the real world makes it something the Government should be getting a national license for!
David.

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