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Effectiveness of a clinical knowledge support system for reducing diagnostic errors in outpatient care in Japan: A retrospective study

Shimizu T., Nemoto T., Tokuda Y. Effectiveness of a clinical knowledge support system for reducing diagnostic errors in outpatient care in Japan: A retrospective study. International Journal of Medical Informatics 109 (2018): 1-4. doi: 10.1016/j.ijmedinf.2017.09.010

To evaluate the effectiveness of UpToDate for reducing diagnostic errors, the study authors retrospectively identified 100 patients who visited an outpatient department in a community-based hospital from July 2014 to June 2015. Half the patients were seen by physicians equipped with UpToDate and half were seen by physicians without UpToDate access. They compared diagnostic error rates between the two groups.

  • The diagnostic error rate for the patients seen by physicians equipped with UpToDate was 2%.
  • The diagnostic error rate for patients seen by physicians not equipped with UpToDate was 24%.
  • Multivariate logistic regression analysis showed that error rate reduction was significantly associated with exposure to UpToDate with an odds ratio of 15.21 (95% CI 1.86–124.36).
  • The results demonstrated the effectiveness of UpToDate for the prevention and reduction of diagnostic error.

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Variable quality and readability of patient-oriented websites on colorectal cancer screening

Schreuders EH, Grobbee EJ, Kuipers EJ, Spaander MC, Veldhuyzen van Zanten SJ. Variable Quality and Readability of Patient-Oriented Websites on Colorectal Cancer Screening. Clin Gastroenterol Hepatol. 2016 Jul 9. pii: S1542-3565(16)30376-7. doi: 10.1016/j.cgh.2016.06.029. [Epub ahead of print].

The efficacy of colorectal cancer (CRC) screening is dependent on participation and subsequent adherence to surveillance. The internet is increasingly used for health information and important to support decision-making. We evaluated the accuracy, quality, and readability of online information on CRC screening and surveillance.

Twenty websites were included. The mean Website Accuracy Score was 26 out of 44 (range 9-41). Websites with the highest scores were cancer.org, bowelcanceraustralia.org and uptodate.com.

There is marked variation in quality and readability of websites on CRC screening. Most websites do not address polyp surveillance. The poor correlation between quality and Google ranking suggests that screenees will miss out on high-quality websites using standard search strategies.

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Can an electronic database help busy physicians answer clinical questions?

Blackman D, Cifu A, Levinson W. Can an electronic database help busy physicians answer clinical questions? J Gen Intern med 2002; 17Suppl1:220.

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.

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Usage of UpToDate at an academic medical center

Maviglia, SM, Martin, MT, Wang, SJ, et al. Usage of UpToDate at an academic medical center. J Gen Inter Med 2002; 17(Suppl1):204.

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

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The impact of evidence on physicians’ inpatient treatment decisions

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:

  • Treatment changed in 18% of patients.
  • Most changed decisions were considered to have improved the care of the patient.

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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

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:

  • 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.

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How doctors make use of online, point-of-care clinical decision support systems: a case study of UpToDate

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.

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

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An evaluation of five bedside information products using a user-centered, task-oriented approach

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.

  • 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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The value of library and information services in patient care: Results of a multisite study

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.

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

graphic from research study

Used with permission from the Medical Library Association

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