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'Most obvious finding ever?' Hospitals' e-tools improve quality

Study connects UpToDate software with patient outcomes

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November 18, 2011

Dan Diamond, Managing Editor

It seems so evident—as plain as the runny nose on a patient's face—that even study author Ashish Jha wonders if it's the "most obvious finding ever?"

But until this week, researchers had never explicitly connected hospitals' rising use of clinical decision support tools to better patient outcomes, at least in a national study.

That new study, conducted by Jha and his fellow Harvard-affiliated authors and published in the Journal of Hospital Medicine, uncovered a clear link between UpToDate, a clinical decision support system, and hospital performance.

Study drew on national Medicare beneficiary data
Thomas Isaac—a physician at Beth Israel Deaconess Medical Center and an instructor at Harvard Medical School—said that the researchers weren't initially sure they'd find an association between the software and outcomes, the Wall Street Journal's "Health Blog" reported.

But reviewing Medicare beneficiary data collected between 2004 and 2006, researchers found that hospitals using UpToDate:

• Achieved higher quality scores for care provided to patients experiencing heart attack, heart failure and pneumonia;
• Reduced the length of hospital stays by approximately 372,500 days annually; and
• Saved about 11,500 lives over three years.

Although UpToDate provided funding for the study, the researchers stressed the company was not involved in the study design or findings.

Takeaways on implementation
The researchers were aware that UpToDate may have been disproportionately adopted by wealthier hospitals, which often possess other advantages and resources that can improve patient outcomes. Despite spending considerable effort, Jha concedes that the team wasn't able to totally solve the "haves" vs. "have-nots" question that's so pervasive in health care.

However, the researchers did find that the benefits of the systems persisted, even after adjusting for characteristics like financial health, teaching status, and Medicaid patient mix. Meanwhile, they conclude that the cost of software like UpToDate isn't prohibitive; a 100-bed hospital would pay annual subscription fees of $10,578 for the system.

The study also captured a moment in time when most hospitals didn't have clinical support systems—70% of hospitals surveyed by the researchers hadn't implemented UpToDate through 2006—but adoption rates have since ticked up, considerably.

The organizations that are more likely to be late adopters? Smaller hospitals, Jha says, "and our data suggest that they get the biggest benefit."

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