Glucose Management Clinical Decision Support to Improve Outcomes in Academic and Community Hospitals

血糖管理临床决策支持可改善学术和社区医院的治疗结果

• 批准号: 10529331
• 负责人: Ariana Raquel Pichardo-Lowden
• 金额: $ 65.06万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-01 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10529331
• 关键词: Acute; Address; Admission activity; Algorithms; Caring; Cessation of life; Clinical; Clinical Decision Support Systems; Clinical Management; Collaborations; Community Hospitals; Competence; Computerized Medical Record; Consultations; Counseling; Data; Data Collection; Decision Making; Diabetes Mellitus; Discipline; Dose; Economics; Eligibility Determination; Exposure to; Frequencies; Glucose; Health; Health Care Costs; Health Services; Hospital Units; Hospitalization; Hospitals; Hour; Hyperglycemia; Hypoglycemia; Infection; Information Technology; Inpatients; Institution; Insulin; Intensive Care; Intensive Care Units; Interruption; Intervention; Intravenous; Judgment; Knowledge; Leadership; Length of Stay; Long-Term Care; Medical Electronics; Mentored Patient-Oriented Research Career Development Award; Modality; National Institute of Diabetes and Digestive and Kidney Diseases; Nosocomial Infections; Outcome; Outcome Study; Patient Admission; Patient Care; Patient-Focused Outcomes; Patients; Performance; Persons; Pilot Projects; Population; Process; Protocols documentation; Provider; Public Health Informatics; Recommendation; Recurrence; Relative Risks; Research; Research Personnel; Resources; Risk; Sample Size; Sampling; Stress; Surgical complication; System; Testing; Time; Time Series Analysis; Work; blood glucose regulation; care delivery; case finding; clinical decision support; compare effectiveness; computerized; cost; data management; design; economic outcome; evidence base; experience; glycemic control; hospital care; hospital readmission; hospital utilization; implementation tool; improved; improved outcome; innovation; instrument; interoperability; medical complication; mortality; mortality risk; multidisciplinary; novel; primary endpoint; process improvement; programs; skills; standard care; statistics; subcutaneous; success; support tools; systematic review; tool; treatment as usual; virtual

Project Summary/Abstract Approximately 9 million patients with diabetes (DM) are hospitalized annually and over 30% of inpatients without DM experience high glucose (HG) due to their acute illness. HG increases the risk of infectious and non- infectious complications and death, hospital length of stay (LOS), utilization of hospital resources and overall healthcare costs. While glucose control reduces these risks, controlling HG in the hospital is difficult due to multiple barriers such as recognizing and proactively treating glucose abnormalities, and adequately ordering insulin to treat HG in the hospital. Clinical decision support (CDS) is a system that uses computerized person- specific data in the electronic medical record (EMR) proven to improve hospital care. Among the various modalities, alert-CDS is shown to improve care delivery, providers’ proactivity, and glucose control specifically in intensive care settings of academic institutions. However, alert-CDS has not yet been studied outside of intensive care units (ICU), or in community hospitals where most patients receive care. Furthermore, its impact on patients’ outcomes has not been tested in any setting. The proposed project uses an innovative alert-CDS tool we developed and validated which automatically identifies dysglycemia and inadequacies in insulin administration in the hospital. It alerts clinicians with recommendations to support decision making without superseding their clinical judgement. In our pilot study, we found that this alert-CDS tool reduced recurrent high glucose levels and shortened LOS. Based on this promising preliminary data, in this project we propose to study the impact of our CDS tool on clinical, economic and providers’ performance outcomes among non-intensive care patients both in an academic and a community hospital. We propose to make this resource available intermittently in the EMR every 3 months during 36 months, thus allowing us to compare 18 months of intervention and 18 months of standard care. Based on our pilot study, we expect that a sample size of 12,560 subjects will give us an 80% power of detecting 0.34 days (~ 8 hours) difference in length of stay, the primary endpoint of our study. We propose the following aims: Aim 1) To determine the impact of the alert-CDS over conventional care on the clinical outcomes of non-ICU patients in an academic and a community hospital. Aim 2) To determine the impact of the alert-CDS over conventional care on the economic outcomes of non-ICU patients in an academic and a community hospital. Aim 3) To determine the impact of alert-CDS for inpatient glycemic control on providers’ perspectives, competencies and practice performance between an academic and a community hospital. We hypothesize that the tool will increase providers’ knowledge about dysglycemia allowing them to make better decisions about insulin administration. The anticipated success of our study builds upon a well-established multidisciplinary team of investigators strongly supported by leadership stakeholders in both hospitals. Our proposed study has the potential of establishing a new paradigm in the management of dysglycemia in hospitalized patients with a major positive impact on clinical and economic outcomes.

项目总结/摘要 每年约有900万糖尿病（DM）患者住院，超过30%的住院患者没有糖尿病。 DM由于其急性疾病而经历高葡萄糖（HG）。HG会增加感染性和非感染性疾病的风险。 感染并发症和死亡，住院时间（LOS），医院资源利用和总体 医疗费用。虽然葡萄糖控制降低了这些风险，但由于以下原因，在医院中控制HG是困难的： 多重障碍，如识别和积极治疗血糖异常，并充分排序 胰岛素治疗HG临床决策支持（CDS）是一个系统，使用计算机化的人- 电子病历（EMR）中的特定数据被证明可以改善医院护理。的各种 模式，alert-CDS被证明可以改善护理提供，提供者的主动性和血糖控制，特别是 在学术机构的重症监护环境中。然而，alert-CDS还没有被研究之外， 重症监护室（ICU）或大多数患者接受护理的社区医院。此外，其影响 对患者预后的影响还没有在任何环境下进行过测试。拟议的项目使用创新的警报-CDS 我们开发并验证了一种工具，可以自动识别胰岛素分泌失调和不足， 医院里的管理。它提醒临床医生提供建议，以支持决策， 取代了他们的临床判断在我们的试点研究中，我们发现这种alert-CDS工具减少了复发性高血压， 葡萄糖水平和缩短的LOS。基于这些有希望的初步数据，在本项目中，我们建议研究 我们的CDS工具对非密集型患者的临床、经济和供应商绩效结果的影响 在学术医院和社区医院照顾病人。我们建议提供这一资源 在36个月期间，每3个月间歇性地在EMR中进行一次，从而使我们能够比较18个月的 干预和18个月的标准护理。根据我们的初步研究，我们预计样本量为12，560 受试者将使我们有80%的把握度检测到住院时间的0.34天（约8小时）差异，主要是 我们研究的终点。我们提出了以下目标：目标1）确定警报CDS对 传统护理对学术和社区医院非ICU患者的临床结局的影响。目的 2)确定alert-CDS相对于传统护理对非ICU患者经济结局的影响 一家学术医院和一家社区医院的病人。目的3）确定alert-CDS对住院患者的影响 血糖控制对提供者的观点，能力和实践表现之间的学术和 社区医院。我们假设，该工具将增加供应商的知识， 让他们对胰岛素的使用做出更好的决定。我们研究的预期成功 在领导利益攸关方的大力支持下， 两家医院我们提出的研究有可能建立一个新的模式，在管理 在住院患者中，对临床和经济结果有重大积极影响。