Are You Up To Date? Central and Eastern Europe & Turkey Bogdan Czubak | UpToDate

John Halamka, MD , CIO CareGroup Healthcare System , Boston, MA “Clinicians don’t need more information. They need the right information.” John Halamka, MD , CIO CareGroup Healthcare System , Boston, MA

Multiple Studies have shown A clinical question arises in 50 – 70 % of the visits / patient contacts 80 % of these questions are about management Only 30 % of questions are answered during or after clinic visits Approximately 70 % of answers would have changed patient management Why don’t they look up the answers? They don’t have time. They don’t have confidence they’ll actually find the answer with the resources and time they have. The sheer volume of clinical information being published is overwhelming (eg. 800 new articles are added to Medline each day). All of the above. Increasing Demands on Clinician Productivity : Less Time and an Increasing Focus on Quality and Error Reduction causes Immense Stress on Medical Delivery Systems and Providers Many studies have shown that while physicians might believe their informational needs are being fulfilled, the reality is quite the opposite. In a landmark study conducted in 1985, reported on the information needs in office practice, this study found that: A clinical question arises in 50 to 70 percent of office visits 80 percent of questions are about management Only 30 percent of questions are answered during or after clinic visits Approximately 70 percent of answers would have changed management This is one example that shows how many clinical questions are going unanswered

Doctors Challenges Knowledge Gap Amount of information Before I tell you about UpToDate, I’d like to start by discussing why we need to be using a resource like UpToDate…. Physicians face a serious predicament in trying to find the right information in the right format at the right time. First of all, they are dealing with “information overload”, as knowledge about diagnostic and therapeutic options expands at an increasingly accelerated pace. On a daily basis, a physician might hear or read about a new diagnostic test; a new way to interpret an existing test; a new medication; a new way to use an existing medication; or various warnings and recommendations for multiple other tests, procedures and treatments. To give one a sense of this information overload, consider these two facts: Over 300,000 new articles are added to the Medline database annually, which equals about 800 new articles every day; meanwhile the Physician’s Desk Reference (PDR) has grown from 77 pages in 1942 to 3,633 pages in 2002 – a rise of almost 5000%.   Physicians are also dealing with increasing time constraints. These constraints are related to an increase in the number of patients seen in a single day, coupled with the fact that physicians need to spend more time documenting these visits for insurers. This significantly decreases their time to look up answers to problems they encounter and to stay current with new information that arises daily. This creates a knowledge gap Time to meet information needs Years

What is UpToDate? UpToDate is a comprehensive evidence-based clinical information resource UpToDate is designed to get physicians the concise, practical answers they need when they need them the most - at the point of care. Our topic reviews are written exclusively for UpToDate by physicians for physicians. Over 4,000 physicians serve as authors. Our content is comprehensive yet concise, and it is fully referenced. It goes through an extensive peer review process to ensure that the information and recommendations you access from our service are accurate and reliable. (Regular revision of contents at least in each 4 months ) UpToDate enables physicians to: Access the most current information within your specialty. Recognize the clinical manifestations of a wide variety of disorders Describe current options for diagnosis, management and therapy, including the efficacy, doses, and interactions of individual drugs. Identify optimal screening and prevention strategies

Quick Facts about UpToDate (version 18.2) 4000+ (international) world-renowned Authors 8.500+ clinical topics in 16 specialties 956 Topics with graded recommendations 4.300+ unique drug entries 95.000+ pages 22.400+ graphics 250.000+ Medline references 400+ journals reviewed 380,000+ users in 130+ countries Available on CD – Rom (individual, library), on PDA (individual) and online (site, individual) Updated every 4 months (44 % of the Topics updated and 188 new Topics in 17.2) New Specialties added soon Written by Physicians for Physicians Funded by Subscribing Physicians and Hospitals

Using UpToDate Is as simple as 1, 2, 3

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UpToDate is Evidence Based See our editorial policy (www.uptodate.com)‏ “EBM is more then only grading” (by G. Guyatt)‏ UpToDate executes a systematic review of the most important resources (including Cochrance, Best Evidence, 377+ Journals)‏ UpToDate follows a hierarchy of evidence consistent with most evidence – based resources UpToDate gives multi-level peer-reviewed recommendations, based upon evidence but also on clinical experience ( „Real world recommendations”)

Evidence Based Medicine Best Clinical Evidence Patient’s Values & Circumstances Clinical Expertise

Features & Specialities Adult and Pediatric Emergency Medicine Adult Primary Care and Internal Medicine Allergy and Immunology Cardiovascular Medicine Endocrinology and Diabetes Family Medicine Gastroenterology and Hepatology Hematology Infectious Diseases Nephrology and Hypertension Neurology Obstetrics, Gynecology and Women’s Health Oncology Pediatrics Pulmonary, Critical Care and Sleep Medicine Rheumatology Specialties in development: Dermatology Psychiatry Surgery

UpToDate Endorsements UpToDate is an official educational program of or offered in cooperation with: American Academy of Pediatrics American College of Obstetricians and Gynecologists American College of Rheumatology American Gastroenterological Association American Society of Nephrology Society of General Internal Medicine The Endocrine Society UpToDate is recommended by: American Academy of Family Physicians

UpToDate’s Drug Database UpToDate includes a full comprehensive drug database including: Brand Names, both U.S. and International Dosing information Pricing information Warnings and Reactions Links to relevant topics Full Natural and Pediatric drug databases included. Interaction database.

Improving medical Knowledge Aquisition with UpToDate Factors associated with medical knowledge acquisition during internal medicine residency McDonald FS, Zeger SL, Kolars JC ( Mayo Clinic) Background: Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition. Objective: To examine associations of learning habits on medical knowledge acquisition. Design, Participants: Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN. Measurements: Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model. Results: When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p < .001). In the year before examination, comparable increases in IM-ITE score were associated with attendance at two curricular conferences per week, score increase of 3.9% (95%CI 2.1%, 5.7%; p < .001), or self-directed reading of an electronic knowledge resource 20 minutes each day, score increase of 4.5% (95%CI 1.2%, 7.8%; p = .008). Other factors significantly associated with IM-ITE performance included: age at start of residency, score decrease per year of increasing age, -0.2% (95%CI -0.36%, -0.042%; p = .01), and graduation from a US medical school, score decrease compared to international medical school graduation, -3.4% (95%CI -6.5%, -0.36%; p = .03). Conclusions: Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training. Abstract in Journal of General Internal Medicine. 2007 Apr 28; [Epub ahead of print]. PMID: 17468889 [PubMed - as supplied by publisher]

Solucient: UpToDate is Associated with Better Health Outcomes UpToDate worked with Solucient(1) to study impact of UpToDate on length of stay, complications and patient safety(2) Compared hospitals with and without access to UpToDate The study adjusted for hospital size, hospital type (teaching vs. non) and geographic location (1) Solucient maintains the nation's largest healthcare database, comprised of more than 26 million discharges per year from 2,900 hospital (2) Int J Med Inform. 2008 Nov;77(11):745-53.

Solucient: Impact of UpToDate Hospitals that used UpToDate had significantly lower risk-adjusted length of stay, on average .167 days/discharge (p<.0001) UpToDate hospitals also had statistically significantly lower complication rates (p<.0476) and lower patient safety outcome rates (p<.0001)

Summary:Impact of usage UpToDate Answering clinical questions at the point of care (bedside usage) Helps to answer questions both for clinicians and residents, students on spot Constantly updated medical infromation results further increase of level of professionalism and knowledge UpToDate has no pop-ups, advertising or sponsors and written by Doctors to Doctors Certified by groups of specialties societies and 16 Covered Specialties and growing (3 in progress ) Evidence based recommendations in associtaion with leading medical Soceties Feedback and e-mail features to spread out the professional knowledge UpToDate helps to improve the quality of medical care: may change the way patient is managed resulting in better patient outcomes / better quality of care. may improve physicians ,residents and students medical knowledge and training results – higher reputation of the site Usage of UpToDate may save time & money (increase efficacy) time savings ranged from 44 minutes to 2.6 hours per week brings savings in hospital length of stay, decreased complication rates, reduce adverse events, less referrals UpToDate is associated with a high degree of user satisfaction UpToDate is preferred to all other information resources currently available Ongoing and future studies will likely demonstrate that UpToDate improves objective measures of the quality of patient care while reducing costs