Data in the service of the Patient is Imporving Patient Outcomes and Patient Safety with Better Data
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Explains about unanswered clinical questions, use of uptodate associate with improved quality.For more information visit: http://www.transformhealth-it.org/
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Data in the service of the Patient is Imporving Patient Outcomes and Patient Safety with Better Data
- 1. 0 Data in the Service of the Patient: Improving Patient Outcomes and Patient Safety with Better Data Greg Adams Vice President Wolters Kluwer | UpToDate gregory.adams@wolterskluwer.com
- 2. 1 Doctors Have Clinical Questions Covell, DG. Ann Intern Med 1985; 103:596; Green, ML. AM J Med 2002; 109:218; Osheroff, JA. Ann Intern Med 1991:575; Ely, JW. J Am Med Inform Assoc 2005; 12:217; Gorman, PN. Med Decis Making 1995; 15:113. Unanswered clinical questions impact patient management decisions Approximately 2 out of 3 clinical encounters generate a question Physicians have approximately 11 clinical questions a day 40%of the time, the clinician knows the answer Answering all clinical questions could change 5 to 8patient management decisions each day
- 3. 2 Staying on top of Medical Knowledge In 1965, only 39 randomized trials were published in medicine. In 2011, there were 21 000, which poses a seemingly insurmountable information challenge for clinical professionals who want to stay current with important information. There is too much information to be able to manage or digest.
- 4. 3 Clinical Decision Support: Getting It Right In the Right Context & Format The Right Guidance At the Right Time The Right Decision
- 5. 4We invite you to review the study data yourself: http://www.uptodate.com/home/research Over 60independent studies Have shown that UpToDate has a direct impact on quality of care and clinical outcomes such as a reduction of complications, mortality, and costs. The Most studied Clinical Decision Support System
- 6. 5 UpToDate Changes Clinical Decisions Phua J, See KC, Khalizah HJ, et al. Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds. Singapore Med J 2012; 53:116. 37% Researchers at Singapore’s National University Hospital report that bedside use of UpToDate led to changes in patient care decisions…
- 7. 6 Use of UpToDate Associated with Improved Outcomes 1. Solucient maintains the nation's largest healthcare database, comprised of more than 26 million discharges per year from 2,900 hospitals. 2. Bonis PA. 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 US. Int J Med Inform 2008; 77:745. Significantly shortens length of stay Significantly lowers complication rates Significantly lowers adverse outcome rates Solucient1 studied the impact of UpToDate on length of stay, complications, and patient safety2
- 8. 7 Researchers at Harvard University Find UpToDate Associated with Improved Outcomes Isaac T, Zheng J, Jha A. Use of UpToDate and outcomes in US hospitals. J Hosp Med 2012; 7:85. Use of UpToDate Associated with... Improved Quality Every condition on Hospital Quality Alliance Metrics Shorter Lengths of Stay 372 000 days over 1 year Lower Mortality Rates 11 500 lives over 3 years
- 9. 8 Economic Impact of UpToDate at Salford Royal NHS Foundation Trust Source: November 2011, Forrester Research: The Total Economic Impact Of UpToDate’s Clinical Decision Support System For Healthcare Institutions: A Case Study Of Salford Royal NHS Foundation Trust in the UK Benefits Included: Staff productivity Diagnostic test efficiencies Improvements in the quality of care Forrester Research found Salford Royal NHS Foundation Trust (SRFT) recovered the costs of UpToDate in 90 days 90= ROI days
- 10. 9 UpToDate has national contracts with the governments of Norway (2010), Iran (2011), Spain (2013), Saudi Arabia (2013), Oman (2014), and Jordan (2015) to standardize care based on UpToDate content. In other countries, such as the USA, The Netherlands, Switzerland, or Luxembourg, UpToDate is used in all hospitals. UpToDate around the world 30 000 hopitals and clinics in 174 countries use UpToDate
- 11. 10 Integrating Clinical Decision Support in the Workflow In the Right Context & Format The Right Guidance At the Right Time The Right Decision
- 12. 11 The Most Valuable HIT Initiative for Patient Care Source: UpToDate individual subscriber survey 2012 Which IT initiative produces the greatest benefit to the quality and safety of patient care? 26.53 31.35 32.68 33.41 36.28 37.39 54.31 20 30 40 50 60 Order sets CPOE Patient ed Alerts/reminders eRx EHR system UpToDate CDS Proportion ranking each initiative a 9 or 10 on a 10 point scale (n = 17,127)
- 13. Is important to patient care Enhances satisfaction with their EHR Encourages utilization of their EHR Increased Clinician Satisfaction with the EHR Source: July 2011 Clinicians Survey N = 1228 Users said that having UpToDate embedded in their EHR 2011 91% 2011 89% 2011 40%
- 14. Is important to patient care Enhances satisfaction with their EHR Encourages utilization of their EHR Increased Clinician Satisfaction with the EHR Source: July 2015 Clinicians Survey N = 2526 Users said that having UpToDate embedded in their EHR 2015 93% 2015 91% 2015 47%
- 15. 14 Conclusion Based on our experience in over 30 000 hospitals around the world, we are convinced that full use of REAL Integrated Clinical Decision Support would help: Improve quality of care Improve medical knowledge Reduce complications Reduce errors This will help save more lives This will help save more money.
Hinweis der Redaktion
- Another well-documented healthcare challenge involves clinicians’ unanswered questions. There have been a number of studies that have looked at the questions that are generated at the point of care. These studies indicate a large number of questions, many of which go unanswered. One study found that approximately 2 out of 3 patient encounters generate a question, but that 60% of these questions go unanswered. And this particular study was focused on the US, where physicians tend to see fewer patients on a daily basis, so outside of the US and Canada where physicians tend to see even more patients, the number of clinical questions that a physician is likely to have per day, and that go unanswered, is likely to be even higher. The reasons why these questions go unanswered varies, and include lack of time, difficulty navigating the overwhelming body of literature, and a belief that an answer does not exist. Regardless of the reason, however, it is clear that answering these questions could have a substantial impact – potentially changing five to eight patient management decisions per day.
- Speaker Notes - Solucient compared hospitals with and without access to UpToDate, and they found that hospitals with UpToDate had significantly shorter lengths of stay (.167 days per discharge), lower complication rates, and better patient safety outcomes than hospitals without UpToDate. They also adjusted for hospital size, type (teaching versus non-teaching), and location. Solucient then looked at whether the amount of usage of UpToDate had any impact on these measures and what they found was… Significantly shortens length of stay Significantly lowers complication rates Significantly lowers adverse outcome rates
- Begin the presentation by introducing the concept of CDS. Explain that an effective CDS solution could fundamentally change clinician decisions that have an impact on patient safety and quality of care, ultimately delivering improved outcomes. (Note that we will look at some studies supporting this impact later in the presentation.) Transition to explain that it is not just the right content that can lead to a change in clinician decisions and improved outcomes, however. To be effective, a CDS solution must help the clinician make the right decision, at the right time, and in the right context and format. Explain that we will touch on these requirements throughout this presentation.
- There have been over 30 independent studies conducted on UpToDate.
- Research done at individual hospitals reinforces the findings from the wider Harvard Outcomes and Solucient studies. In a study published in the Singapore Medical Journal, researchers at Singapore’s National University Hospital found that use of UpToDate led to changes in investigations, diagnosis or management 37% of the time. In other words, patient management decisions were changed more than one-third of the time when UpToDate was consulted. The body of research on UpToDate all supports the premise that UpToDate has measurable benefits and positively impacts patient outcomes.
- Speaker Notes - Solucient compared hospitals with and without access to UpToDate, and they found that hospitals with UpToDate had significantly shorter lengths of stay (.167 days per discharge), lower complication rates, and better patient safety outcomes than hospitals without UpToDate. They also adjusted for hospital size, type (teaching versus non-teaching), and location. Solucient then looked at whether the amount of usage of UpToDate had any impact on these measures and what they found was… Significantly shortens length of stay Significantly lowers complication rates Significantly lowers adverse outcome rates
- Researchers at Harvard University conducted a similar study, but with stricter methodological controls. And what they found was a confirmation of the Solucient study – plus an association with additional benefits. These researchers found that use of UpToDate over a three-year period was associated with statistically significant improved quality on every condition on the Hospital Quality Alliance Metrics, including lower lengths of stay, as well as lower mortality rates for three medical conditions. The study concluded that use of UpToDate would have been tied to 372,000 fewer patient days in the hospital per year, and 11,500 lives saved every 3 years. **Additional information on the study that you can share in your presentation as needed: This was a retrospective study using data from 3,322 hospitals in the United States (a nationwide study of all hospitals) over a three-year period. It compared the outcomes between those that adopted UpToDate (1,017 hospitals) and those that did not (2,305 hospitals) using strict methodological controls. The conditions on the Hospital Quality Alliance Metrics include: Acute myocardial infarction Congestive heart failure Gastrointestinal hemorrhage Pneumonia Stroke Hip fracture
- In a more business-oriented report, Forrester Research concluded that Salford Royal NHS Foundation Trust in the UK realized a Return on Investment (ROI) for UpToDate in just 90 days. Benefits that the report quantified included staff productivity, diagnostic test efficiencies, and improvements in the quality of care.
- Speaker Notes - When our valued customers are asked what makes UpToDate different, they mention that they put trust in UpToDate for trusted, reliable, evidence based peer reviewed editorial content. UpToDate is by far the dominant clinical knowledge resource worldwide, with: The most trusted, evidence-based, peer-reviewed editorial content that is proven to improve patient care and quality. The trust and confidence of over 700,000 clinicians and 25,000 hospitals worldwide: The following teaching medical institutions: 95% in Benelux 95% in Germany 86% in Japan 90% in The United States Countries including Norway and Spain have standardized on UpToDate Expert-led evidence-based recommendations and consensus of over 5000 physician authors from 51 countries
- Begin the presentation by introducing the concept of CDS. Explain that an effective CDS solution could fundamentally change clinician decisions that have an impact on patient safety and quality of care, ultimately delivering improved outcomes. (Note that we will look at some studies supporting this impact later in the presentation.) Transition to explain that it is not just the right content that can lead to a change in clinician decisions and improved outcomes, however. To be effective, a CDS solution must help the clinician make the right decision, at the right time, and in the right context and format. Explain that we will touch on these requirements throughout this presentation.
- Clinicians report that UpToDate is the highest IT benefit to patient care. Results from UpToDate Individual Subscriber Survey 2012. Survey question asked subscribers to rate IT initiatives regarding their impact on the quality and safety of patient care. Respondents were asked to rate each item on a scale of 1-10, with 1 indicating least important, and 10 most important. UpToDate ranked highest of all initiatives with a mean rating of 8.4, compared with 7.3 for the next highest ranking item, patient education materials. We know your organizations plate is very full with various projects to increase efficiencies and improve care and quality. However, clinicians rank UTD the most valuable HIT initiative within their organization. For the clinicians and hospital staff and librarians you work with, implementation of UTD will help your colleagues achieve many of their key goals around quality and efficiency. We know you have numerous IT projects you can deploy, but UTD requires minimal IT resources and investment and will provide significant benefits to your internal customers and is almost guaranteed to have high adoption rates based on our discussion earlier about how clinicians love UTD – just go out an ask your staff if they have heard of UTD.
- Integrating UpToDate increases physician satisfaction. We conducted a survey of over 2,500 customers who have UpToDate embedded in their EHR. The result: 93% report having UpToDate in their EHR is important to patient care; 91% said it enhances their satisfaction with their EHR and 47% reported that having UpToDate in their EHR in and of itself encouraged them to use their EHR.
- Integrating UpToDate increases physician satisfaction. We conducted a survey of over 2,500 customers who have UpToDate embedded in their EHR. The result: 93% report having UpToDate in their EHR is important to patient care; 91% said it enhances their satisfaction with their EHR and 47% reported that having UpToDate in their EHR in and of itself encouraged them to use their EHR.
- Introduce the presentation with its goal to communicate some of the benefits UpToDate’s Clinical Decision Support (CDS) solution offers institutions, focused particularly on the business benefits. [Recall that this version of the presentation is targeted at IT management executives.]