Diabetes and Hyperglycemia Quality Improvement Efforts in Hospitals in the United States: Current Status, Practice Variation, and Barriers to Implementation

Cook, Curtiss B.; Elias, Beth L.; Kongable, Gail L.; Potter, Daniel; Shepherd, Katherine M.; McMahon, David

doi:10.4158/ep09234.or

Cited by 46 publications

(37 citation statements)

References 37 publications

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“…6 This inconsistency in recommended glucose targets may partially explain the variation in glucose goals practiced by different hospitals across the United States. 7 Additionally, neither individual practitioners [38][39][40][41] nor hospitals 7 have standardized definitions for biochemical hypoglycemia. These standards should be established before implementation of a national benchmarking process.…”

Section: Which Glucose Ranges Should Hospitals Be Targeting?mentioning

confidence: 99%

“…Moreover, clinicians depend on real-time results of POC-BG testing to make immediate adjustments in therapy for hyperglycemia rather than waiting for clinical laboratory results. POC-BG measurements are the preferred method hospitals use for monitoring glucose levels 7 and are an integral part of inpatient glucose control initiatives. 45 Nonetheless, POC-BG measurements have potential drawbacks that may affect data quality by introducing errors into analyses that could subsequently affect conclusions about a hospital's glycemic control.…”

Section: Which Sample Sources Should Be Analyzed?mentioning

confidence: 99%

“…4,5,37 Data from the survey cited earlier found hospitals interested in a variety of metrics, including infection rates and length of stay, but the top three metrics that hospitals were interested in tracking were frequency of hypoglycemia, frequency of hyperglycemia, and average glucose by hospital unit. 7 Thus, whichever consensus inpatient glucose reporting measures are adopted, some consideration should be given to those areas of greatest interest to hospitals and to the data they find most meaningful to pass on to their stakeholders. Hospital representation in the discussion on glucometrics should be paramount to ensure buy-in and compliance with the standardized measures that are adopted.…”

Section: What Are Hospital Interests?mentioning

confidence: 99%

“…[4][5][6] Third, a recent survey of U.S. hospitals indicated that many have either fully or partially implemented inpatient diabetes quality improvement programs and as these initiatives go live, they will require metrics by which to assess their impact on glucose control. 7 Yet, nearly one-third of these hospitals have indicated that they had no metrics in place to assess the outcomes of their glucose management programs. Finally, pay-for-performance requirements are beginning to emerge that are applicable to inpatient diabetes management.…”

Section: Introductionmentioning

confidence: 99%

“…7 If hospitals are going to be asked to provide information on their inpatient glucose control efforts, then inexpensive, accessible informatics tools must be made available that will enable them to gather and report the necessary data. For hospitals with limited internal information technology capabilities, applications exist that allow institutions to connect to and import hospitalspecific glucose values into external data management systems.…”

mentioning

confidence: 99%

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Assessing Inpatient Glycemic Control: What are the Next Steps?

Cook¹,

Wellik

Kongable

et al. 2012

J Diabetes Sci Technol

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Abbreviations: (POC-BG) AbstractDespite the emergence of glucometrics (i.e., systematic analysis of data on blood glucose levels of inpatients) as a subject of high interest, there remains a lack of standardization on how glucose parameters are measured and reported. This dilemma must be resolved before a national benchmarking process can be developed that will allow institutions to track and compare inpatient glucose control performance against established guidelines and that can also be supported by quality care organizations. In this article, we review some of the questions that need to be resolved through consensus and review of the evidence, and discuss some of the limitations in analyzing and reporting inpatient glucose data that must be addressed (or at least accepted as limitations) before hospitals can commit resources to gathering, compiling, and presenting inpatient glucose statistics as a health care quality measure. Standards must include consensus on which measures to report, the unit of analysis, definitions of targets for hyperglycemia treatment, a definition of hypoglycemia, determination of how data should be gathered (from chart review or from laboratory information systems), and which type of sample (blood or point of care) should be used for analysis of glycemic control. Hospitals and/or their representatives should be included in the discussion. For inpatient glucose control to remain a focus of interest, further dialogue and consensus on the topic are needed.

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Section: Which Glucose Ranges Should Hospitals Be Targeting?mentioning

confidence: 99%

Section: Which Sample Sources Should Be Analyzed?mentioning

confidence: 99%

Section: What Are Hospital Interests?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Assessing Inpatient Glycemic Control: What are the Next Steps?

Cook¹,

Wellik

Kongable

et al. 2012

J Diabetes Sci Technol

Self Cite

View full text Add to dashboard Cite

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Point‐of‐care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients

Nya-Ngatchou

Corl

Onstad

et al. 2014

Diabetes Metabolism Res

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Documentation of point-of-care blood glucose measurement errors likely overestimates ICU hypoglycaemia rates and can be reduced by a quality improvement effort. The currently used hypoglycaemic patient-day metric does not evaluate recurrent or prolonged events that may be more likely to cause patient harm. The monitored patient-day as currently defined may not be the optimal denominator to determine inpatient hypoglycaemic risk.

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