A Gap Analysis Needs Assessment Tool to Drive a Care Delivery and Research Agenda for Integration of Care and Sharing of Best Practices Across a Health System

Golden, Sherita Hill; Hager, D.N.; Gould, Lois; Mathioudakis, Nestoras; Pronovost, Peter J.

doi:10.1016/j.jcjq.2016.10.004

Cited by 26 publications

(30 citation statements)

References 10 publications

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“…Glucometrics dashboard. The IDMS at Johns Hopkins Hospital in collaboration with the Johns Hopkins Armstrong Institute for Patient Safety and Quality and Diabetes Clincal Communities developed a glucometrics dashboarda readily accessible online platform which assessed a number of glycemic-related metrics in the five hospitals of the Johns Hopkins Health System in Maryland and Washington, DC[19,21].…”

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confidence: 99%

Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Mandel

Langan

Mathioudakis

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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Background: Hospitalized patients with diabetes are at risk of complications and longer length of stay (LOS). Inpatient Diabetes Management Services (IDMS) are known to be beneficial; however, their impact on patient care measures in community, non-teaching hospitals, is unknown. Objectives: To evaluate whether co-managing patients with diabetes by the IDMS team reduces LOS and 30-day readmission rate (30DR). Methods: This retrospective quality improvement cohort study analyzed LOS and 30DR among patients with diabetes admitted to a community hospital. The IDMS medical team consisted of an endocrinologist, nurse practitioner, and diabetes educator. The comparison group consisted of hospitalized patients with diabetes under standard care of attending physicians (mostly internal medicine-trained hospitalists). The relationship between study groups and outcome variables was assessed using Generalized Estimating Equation models. Results: 4,654 patients with diabetes (70.8 ± 0.2 years old) were admitted between January 2016 and May 2017. The IDMS team co-managed 18.3% of patients, mostly with higher severity of illness scores (p < 0.0001). Mean LOS in patients co-managed by the IDMS team decreased by 27%. Median LOS decreased over time in the IDMS group (p = 0.046), while no significant decrease was seen in the comparison group. Mean 30DR in patients comanaged by the IDMS decreased by 10.71%. Median 30DR decreased among patients comanaged by the IDMS (p = 0.048). Conclusions: In a community hospital setting, LOS and 30DR significantly decreased in patients co-managed by a specialized diabetes team. These changes may be translated into considerable cost savings.

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confidence: 99%

Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Mandel

Langan

Mathioudakis

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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“…To identify local gaps in inpatient glucose management education, we administered a gap analysis survey to diabetes champions to each of the adult hospitals in our health system. 22 The diabetes champions were designated clinicians (physicians or nurses) who oversaw diabetes management and education at each hospital. This survey was developed with a broad representation of key stakeholders at each of our hospitals, assembled through the Diabetes Clinical Community of the Armstrong Institute for Patient Safety and Quality.…”

Section: Methodsmentioning

confidence: 99%

“…This survey was developed with a broad representation of key stakeholders at each of our hospitals, assembled through the Diabetes Clinical Community of the Armstrong Institute for Patient Safety and Quality. 22,23 A section of this survey was focused on professional education in inpatient glucose management, and respondents were asked to report whether education on individual topics at their hospital was mandatory, optional, or not offered. Results of the gap analysis tool were synthesized to identify the most prevalent gaps in inpatient glucose management education.…”

Section: Methodsmentioning

confidence: 99%

Development, Implementation, and Evaluation of a Physician-Targeted Inpatient Glycemic Management Curriculum

Mathioudakis

Bashura

Boyer

et al. 2019

Journal of Medical Education and Curricular Development

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Objective: Diabetes is prevalent among hospitalized patients and there are multiple challenges to attaining glycemic control in the hospital setting. We sought to develop an inpatient glycemic management curriculum with stakeholder input and to evaluate the effectiveness of this educational program on glycemic control in hospitalized patients. Methods: Using the Six-Step Approach of Kern to Curriculum Development for Medical Education, we developed and implemented an educational curriculum for inpatient glycemic management targeted to internal medicine residents and hospitalists. We surveyed physicians (n = 73) and conducted focus group sessions (n = 18 physicians) to solicit input regarding educational deficits and desired format of the educational intervention. Based on feedback from the surveys and focus groups, we developed educational goals and objectives and a case-based curriculum, which was delivered over a 1-year period via in-person teaching sessions by 2 experienced diabetes physicians at 3 hospitals. Rates of hypoglycemia and hyperglycemia were evaluated among at-risk patient days using an interrupted time-series design. Results: We developed a mnemonic-based (SIGNAL) curriculum consisting of 10 modules, which covers key concepts of inpatient glycemic management and provides an approach to daily glycemic management: S = steroids, I = insulin, G = glucose, N = nutritional status, A = added dextrose, and L = labs. Following implementation of the curriculum, there was no difference in the rates of hyperglycemia in insulin-treated patients following the intervention; however, there was an increase in the rates of hypoglycemia defined as blood glucose (BG) ⩽ 70 mg/dL (5.6% vs 3.0%, P < .001) and clinically significant hypoglycemia defined as BG < 54 mg/dL (1.9% vs 0.8%, P = .01). There was poor penetration of the curriculum, with 60%, 20%, and 90% of the learning modules being delivered at the three participating hospitals, respectively. Conclusions: In this pilot study, a physician-targeted educational curriculum was not associated with improved glycemic control. Adapting the intervention to increase penetration and integrating the curriculum into existing clinical decision support tools may improve the effectiveness of the educational program on glycemic outcomes.

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“…This form of analysis has been used previously to evalu ate medical institutional performance 21 and improve dissemination of best health care practices across institutions. 22 For each PJI case, specific features of the preoperative PJI workup, intraoperative workup and surgical treatment, and postoperative PJI management were compared with recommendations from the unified clinical standard to determine the rate of physician adherence. We tabulated the number of guideline statements fulfilled for each case.…”

Section: Methodsmentioning

confidence: 99%

Tertiary care centre adherence to unified guidelines for management of periprosthetic joint infections: a gap analysis

Armstrong

Carli

Abdelbary

et al. 2018

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Background:The success rate of surgical treatment for periprosthetic joint infection (PJI) remains inconsistent in the literature. Variability in PJI clinical guidelines and surgeon adherence to guidelines could affect treatment success. The objectives of this study were to appraise current recommendations for PJI management and develop a unified clinical standard of care, to perform a gap analysis of PJI cases in a tertiary institution to determine the rate of guideline adherence, and to determine if adherence to unified PJI guidelines affected 2-year treatment outcomes. Methods: We appraised the PJI guidelines from 3 academic medical societies, and consistent statements were aggregated. We retrospectively reviewed all PJI cases in a tertiary care institution. We defined PJI based on Musculoskeletal Infection Society PJI criteria. Surgeon adherence to preoperative, intraoperative, surgical and medical management guidelines was calculated, and we evaluated the association between guideline adherence and 2-year treatment outcomes. Results: The institutional rate of PJI was 1.13% (38 of 3368). Treatment success was 57.8% at 2 years. Unified guideline adherence percentages varied substantially: 92% of patients had preoperative erythrocyte sedimentation rate and C-reactive protein, 97% had intraoperative tissue cultures, 42% had appropriate preoperative arthrocentesis, and 74% underwent guideline-appropriate surgery. Performing appropriate preoperative arthrocentesis significantly correlated with positive treatment outcomes at 2 years (p = 0.028). Conclusion: Adherence to PJI guidelines varies considerably, indicating that clinicians are either unaware of them or do not recognize their value for PJI treatment. This study shows the need for institution-based PJI treatment pathways that are consistent with published guidelines and the need to monitor adherence. Contexte :Les études ne concordent pas quant au taux de réussite du traitement chirurgical des infections de prothèses articulaires (IPA). Une certaine variabilité dans les lignes directrices sur ces infections et dans l'adhésion des chirurgiens à celles-ci pourrait nuire à la réussite du traitement. La présente étude visait à évaluer les recommandations actuelles sur la prise en charge des IPA afin d'élaborer une norme de soins uniforme, à effectuer une analyse des lacunes entourant les cas d'IPA dans un établissement de soins tertiaires pour déterminer le taux d'adhésion aux lignes directrices, et à déterminer si l'adhésion à des lignes directrices uniformes influençait les issues de traitement après 2 ans. Méthodes : Nous avons évalué les lignes directrices sur les IPA de 3 sociétés médi-cales universitaires, et agrégé des énoncés cohérents. Nous avons également examiné de façon rétrospective tous les cas d'IPA dans un établissement de soins tertiaires. Aux fins de notre étude, l'IPA était définie selon les critères de la Musculoskeletal Infection Society. Nous avons calculé l'adhésion des chirurgiens aux lignes directrices de prise en charge préopératoire, ...

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A Gap Analysis Needs Assessment Tool to Drive a Care Delivery and Research Agenda for Integration of Care and Sharing of Best Practices Across a Health System

Cited by 26 publications

References 10 publications

Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Development, Implementation, and Evaluation of a Physician-Targeted Inpatient Glycemic Management Curriculum

Tertiary care centre adherence to unified guidelines for management of periprosthetic joint infections: a gap analysis

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