Use of UpToDate and outcomes in US hospitals

J Hosp Med. 2012 Feb;7(2):85-90. doi: 10.1002/jhm.944. Epub 2011 Nov 16.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Databases, Factual
  • Hospital Information Systems / statistics & numerical data*
  • Hospital Mortality / trends*
  • Hospitals / standards*
  • Hospitals / trends
  • Humans
  • Length of Stay / trends*
  • Outcome and Process Assessment, Health Care / standards*
  • Outcome and Process Assessment, Health Care / trends
  • Retrospective Studies
  • United States