Tuesday, November 22, 2011

Does Up To Date save lives?

Maybe so according to this study in which hospital outcomes were compared based on use or non-use of Up To Date:

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 less than 0.001) and among 6 prespecified conditions (range, −0.1 to −0.3 days; P less than 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 less than 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.

The study, by the way, according to the WSJ Health Blog, was funded by Up To Date. It passes the test of plausibility for me, and supports my long held contention that doctors need “tools not rules.” I hope we see more research in this exciting area.