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Use of UpToDate and outcomes in US hospitals


  • Thomas Isaac MD, MBA, MPH,

    1. Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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  • Jie Zheng PhD,

    1. Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
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  • Ashish Jha MD, MPH

    Corresponding author
    1. Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
    2. Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
    3. VA Boston Healthcare System, Boston, Massachusetts
    • Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115
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    • Telephone: 617-432-5551; Fax: 617-432-4494

  • Disclosures: This study was funded by UpToDate, Inc. The funder had no role in study design, input into analyses presented, drafting or editing the manuscript, nor saw the manuscript prior to submission.

  • All coauthors have seen and agree with the contents of the manuscript. Drs. Jha and Isaac jointly wrote all drafts of the manuscript with no input from any outside sources. Dr. Zheng reviewed the Methods section and provided editorial comments on all sections of the paper.



Computerized clinical knowledge mana-gement systems hold enormous potential for improving quality and efficiency. However, their impact on clinical practice is not well known.


To examine the impact of UpToDate on outcomes of care.


Retrospective study.


National sample of US inpatient hospitals.


Fee-for-service Medicare beneficiaries.


Adoption of UpToDate in US hospitals.


Risk-adjusted lengths of stay, mortality rates, and quality performance.


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.


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. Journal of Hospital Medicine 2012. © 2011 Society of Hospital Medicine.