title: Diabetes and hyperglycemia quality improvement efforts in hospitals in the United States: current status, practice variation, and barriers to implementation.
abstract: OBJECTIVE
  To determine the status of diabetes and hyperglycemia quality improvement efforts in hospitals in the United States.
  
  
  METHODS
  We designed and administered a survey to a convenience sample of hospitals, and the responses were analyzed statistically.
  
  
  RESULTS
  We received 269 responses from 1,151 requested surveys. The sample was similar to hospitals in the United States on the basis of hospital type and geographic region (P = no significant difference) but not on the basis of number of beds (P<.001). Among responding hospitals, 39%, 21%, and 15% had fully implemented inpatient diabetes and hyperglycemia quality improvement programs for critically ill, non-critically ill, and perioperative patients, respectively. Moreover, 77%, 44%, and 49% had fully implemented protocols for hypoglycemia, hyperglycemic crises, and diabetic ketoacidosis, respectively. Variations in glucose target ranges were noted. The responding hospitals had no standard biochemical definition of hypoglycemia; 47% defined hypoglycemia as a glucose level <or=70 mg/dL, but 29%, 8%, 6%, and 4% used <60, <50, <40, and <80 mg/dL, respectively. Almost a third of reporting hospitals had no metric to track the quality of inpatient diabetes and hyperglycemia care. More than half (59%) indicated that they did not have an automated capability to extract and analyze glucose data. The most frequent barrier to implementing a glycemic control program was concern regarding hypoglycemia (61%).
  
  
  CONCLUSIONS
  Hospitals are addressing the issue of inpatient diabetes and glycemic control but face obstacles to implementation of quality improvement programs and vary in their approach to management. Improving the consistency of glucose control practices within hospitals in the United States should help enhance patient care and safety. Future efforts to help hospitals overcome barriers to introducing glucose control programs could include developing standardized glycemic control metrics, improving data collection and reporting methods, and providing improved tools that enable clinicians to control glucose safely.
authors.affiliation: Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
authors.forename: Beth
authors.initials: B
authors.lastname: Elias
authors.forename: Gail L
authors.initials: GL
authors.lastname: Kongable
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Potter
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Shepherd
authors.forename: David
authors.initials: D
authors.lastname: McMahon
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003920:Diabetes Mellitus; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D006943:Hyperglycemia; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D014481:United States