Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes
Introduction Innovative approaches are needed to design robust clinical decision support (CDS) to optimize hospital glycemic management. We piloted an electronic medical record (EMR), evidence-based algorithmic CDS tool in an academic center to alert clinicians in real time about gaps in care relate...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e001557.full |
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| author | Guillermo Umpierrez Vernon M Chinchilli Erik B Lehman Ariana Pichardo-Lowden Matthew D Bolton Christopher J DeFlitch Paul M Haidet |
| author_facet | Guillermo Umpierrez Vernon M Chinchilli Erik B Lehman Ariana Pichardo-Lowden Matthew D Bolton Christopher J DeFlitch Paul M Haidet |
| author_sort | Guillermo Umpierrez |
| collection | DOAJ |
| description | Introduction Innovative approaches are needed to design robust clinical decision support (CDS) to optimize hospital glycemic management. We piloted an electronic medical record (EMR), evidence-based algorithmic CDS tool in an academic center to alert clinicians in real time about gaps in care related to inpatient glucose control and insulin utilization, and to provide management recommendations.Research design and methods The tool was designed to identify clinical situations in need for action: (1) severe or recurrent hyperglycemia in patients with diabetes: blood glucose (BG) ≥13.88 mmol/L (250 mg/dL) at least once or BG ≥10.0 mmol/L (180 mg/dL) at least twice, respectively; (2) recurrent hyperglycemia in patients with stress hyperglycemia: BG ≥10.0 mmol/L (180 mg/dL) at least twice; (3) impending or established hypoglycemia: BG 3.9–4.4 mmol/L (70–80 mg/dL) or ≤3.9 mmol/L (70 mg/dL); and (4) inappropriate sliding scale insulin (SSI) monotherapy in recurrent hyperglycemia, or anytime in patients with type 1 diabetes. The EMR CDS was active (ON) for 6 months for all adult hospital patients and inactive (OFF) for 6 months. We prospectively identified and compared gaps in care between ON and OFF periods.Results When active, the hospital CDS tool significantly reduced events of recurrent hyperglycemia in patients with type 1 and type 2 diabetes (3342 vs 3701, OR=0.88, p=0.050) and in patients with stress hyperglycemia (288 vs 506, OR=0.60, p<0.001). Hypoglycemia or impending hypoglycemia (1548 vs 1349, OR=1.15, p=0.050) were unrelated to the CDS tool on subsequent analysis. Inappropriate use of SSI monotherapy in type 1 diabetes (10 vs 22, OR=0.36, p=0.073), inappropriate use of SSI monotherapy in type 2 diabetes (2519 vs 2748, OR=0.97, p=0.632), and in stress hyperglycemia subjects (1617 vs 1488, OR=1.30, p<0.001) were recognized.Conclusion EMR CDS was successful in reducing hyperglycemic events among hospitalized patients with dysglycemia and diabetes, and inappropriate insulin use in patients with type 1 diabetes. |
| format | Article |
| id | doaj-art-cf8a96ae860b436c87fafc285a2d3cfd |
| institution | Kabale University |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-cf8a96ae860b436c87fafc285a2d3cfd2024-12-12T13:00:09ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2020-001557Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomesGuillermo Umpierrez0Vernon M Chinchilli1Erik B Lehman2Ariana Pichardo-Lowden3Matthew D Bolton4Christopher J DeFlitch5Paul M Haidet6Medicine, Emory University School of Medicine, Atlanta, Georgia, USA1 Public Health Sciences, Penn State College of Medicine, Hershey, PA, United StatesDepartment of Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USADepartment of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USADepartment of Information Services, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USADepartment of Emergency Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USADepartment of Medicine, Public Health Sciences, and Humanities, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USAIntroduction Innovative approaches are needed to design robust clinical decision support (CDS) to optimize hospital glycemic management. We piloted an electronic medical record (EMR), evidence-based algorithmic CDS tool in an academic center to alert clinicians in real time about gaps in care related to inpatient glucose control and insulin utilization, and to provide management recommendations.Research design and methods The tool was designed to identify clinical situations in need for action: (1) severe or recurrent hyperglycemia in patients with diabetes: blood glucose (BG) ≥13.88 mmol/L (250 mg/dL) at least once or BG ≥10.0 mmol/L (180 mg/dL) at least twice, respectively; (2) recurrent hyperglycemia in patients with stress hyperglycemia: BG ≥10.0 mmol/L (180 mg/dL) at least twice; (3) impending or established hypoglycemia: BG 3.9–4.4 mmol/L (70–80 mg/dL) or ≤3.9 mmol/L (70 mg/dL); and (4) inappropriate sliding scale insulin (SSI) monotherapy in recurrent hyperglycemia, or anytime in patients with type 1 diabetes. The EMR CDS was active (ON) for 6 months for all adult hospital patients and inactive (OFF) for 6 months. We prospectively identified and compared gaps in care between ON and OFF periods.Results When active, the hospital CDS tool significantly reduced events of recurrent hyperglycemia in patients with type 1 and type 2 diabetes (3342 vs 3701, OR=0.88, p=0.050) and in patients with stress hyperglycemia (288 vs 506, OR=0.60, p<0.001). Hypoglycemia or impending hypoglycemia (1548 vs 1349, OR=1.15, p=0.050) were unrelated to the CDS tool on subsequent analysis. Inappropriate use of SSI monotherapy in type 1 diabetes (10 vs 22, OR=0.36, p=0.073), inappropriate use of SSI monotherapy in type 2 diabetes (2519 vs 2748, OR=0.97, p=0.632), and in stress hyperglycemia subjects (1617 vs 1488, OR=1.30, p<0.001) were recognized.Conclusion EMR CDS was successful in reducing hyperglycemic events among hospitalized patients with dysglycemia and diabetes, and inappropriate insulin use in patients with type 1 diabetes.https://drc.bmj.com/content/9/1/e001557.full |
| spellingShingle | Guillermo Umpierrez Vernon M Chinchilli Erik B Lehman Ariana Pichardo-Lowden Matthew D Bolton Christopher J DeFlitch Paul M Haidet Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes BMJ Open Diabetes Research & Care |
| title | Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes |
| title_full | Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes |
| title_fullStr | Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes |
| title_full_unstemmed | Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes |
| title_short | Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes |
| title_sort | clinical decision support to improve management of diabetes and dysglycemia in the hospital a path to optimizing practice and outcomes |
| url | https://drc.bmj.com/content/9/1/e001557.full |
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