Use of UpToDate and outcomes in US hospitals.

BACKGROUND Computerized clinical knowledge mana-gement 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.