Implementing and evaluating a multicomponent inpatient diabetes management program: putting research into practice.
BACKGROUND
Strategies for successful implementation of hospitalwide glucose control efforts were addressed in a conceptual model for the development and implementation of an institutional inpatient glucose management program. CONCEPTUAL MODEL COMPONENTS: The Glucose Steering Committee incrementally developed and implemented hospitalwide glucose policies, coupled with targeted education and clinical decision support to facilitate policy acceptance and uptake by staffwhile incorporating process and outcome measures to objectively assess the effectiveness of quality improvement efforts. The model includes four components: (1) engaging staff and hospital executives in the importance of inpatient glycemic management, (2) educating staff involved in the care of patients with diabetes through structured knowledge dissemination, (3) executing evidence-based inpatient glucose management through development of policies and clinical decision aids, and (4) evaluating intervention effectiveness through assessing process measures, intermediary glucometric outcomes, and clinical and economic outcomes. An educational curriculum for nursing, provider, and pharmacist diabetes education programs and current glucometrics were also developed.


RESULTS
Overall the average patient-day-weighted mean blood glucose (PDWMBG) was below the currently recommended maximum of 180 mg/dL in patients with diabetes and hyperglycemia, with a significant decrease in PDWMBG of 7.8 mg/dL in patients with hyperglycemia. The program resulted in an 18.8% reduction in hypoglycemia event rates, which was sustained.


CONCLUSIONS
Inpatient glucose management remains an important area for patient safety, quality improvement, and clinical research, and the implementation model should guide other hospitals in their glucose management initiatives.
Johns Hopkins University School of Medicine, Baltimore, USA.
Miguel
M
Munoz
Peter
P
Pronovost
Joanne
J
Dintzis
Theresa
T
Kemmerer
Nae-Yuh
NY
Wang
Yi-Ting
YT
Chang
Leigh
L
Efird
Sean M
SM
Berenholtz
Sherita Hill
SH
Golden
D001786:Blood Glucose; D020000:Decision Support Systems, Clinical / Q000458:organization & administration; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D019468:Disease Management; D006284:Health Plan Implementation / Q000379:methods*; D006739:Hospital Administration; D006801:Humans; D007297:Inpatients; D007318:Inservice Training / Q000458:organization & administration; D057766:Policy; D011367:Professional Staff Committees / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*
D001786:Blood Glucose