Innovations Reducing Hyper-and Hypo-glycemic events in Inpatients

减少住院患者高血糖和低血糖事件的创新

• 批准号: 8150651
• 负责人: GREG MAYNARD
• 金额: $ 29.83万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2013-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8150651
• 关键词: Innovations; Reducing; Hyper; Hypo; glycemic

DESCRIPTION (provided by applicant): Uncontrolled hyperglycemia (high glucose levels) and iatrogenic hypoglycemia (low blood glucose levels) are both recognized and pervasive safety issues in the hospital, in patients with and without diabetes. These largely preventable conditions are associated with prolonged hospital stays, increased infection rates, dehydration, electrolyte disturbances, and other undesirable outcomes. Reports summarizing glucose control, hypoglycemia, and insulin use patterns typically are formulated long after the inpatients with suboptimal control have been discharged, thus safe and effective regimens for glycemic control remain vastly underutilized. Our objective is establish a new benchmark for safe and effective glycemic control in the non-critical care setting over a two year period. We will achieve this goal by introducing near real-time measurement of glucose control and related medications used for glucose control, and using these measurements to spur concurrent interventions on patients who are poorly controlled and non- adherent to institutionally endorsed "best practice" treatment regimens. The interventions include pre- authorized triggered consultation by glucose control experts, electronic and human alerts to treating physicians, and real time displays of patients requiring a change in their regimen to the front line providers. The percentage of monitored inpatients with uncontrolled hyper- and hypo- glycemia during the intervention years will be compared to the baseline performance. This strategy of measurement and concurrent intervention, termed measure-vention, will be outlined in toolkits, assisting other institutions to achieve the same objective. The toolkit will be widely disseminated via the Society of Hospital Medicine and other web based venues, acting as a centerpiece for collaborative improvement efforts involving a wide variety of medical centers. PUBLIC HEALTH RELEVANCE: Our objectives are to establish a new benchmark for keeping glucose values in acceptable ranges in non-critical care inpatients admitted with diabetes and hyperglycemia (high blood sugars), and to disseminate a web-based toolkit allowing medical centers across the country to achieve the same benchmark. A strategy of "measure-vention" (real-time measurement and identification of patients with uncontrolled glucose spurring timely and innovative interventions, including pre-authorized triggered consultation by glucose control experts and alerts to providers) will be used to accelerate improvement and adoption of protocol-driven best practice regimens and order sets. Because uncontrolled hyperglycemia and iatrogenic hypoglycemia (low sugars) are pervasive and largely preventable safety issues in the hospital associated with prolonged hospital stays, increased infection rates, dehydration, electrolyte disturbances, and other undesirable outcomes, innovations to reduce these conditions with methods portable to other medical centers would be a significant advance in public health.

描述(申请人提供)：未控制的高血糖(高血糖水平)和医源性低血糖(低血糖水平)在医院中都是公认的和普遍存在的安全问题，无论是患有还是不患有糖尿病的患者。这些在很大程度上可以预防的情况与住院时间延长、感染率增加、脱水、电解质紊乱和其他不良后果有关。总结血糖控制、低血糖和胰岛素使用模式的报告通常是在控制不佳的住院患者出院后很长一段时间才制定的，因此安全有效的血糖控制方案仍未得到充分利用。我们的目标是在两年的时间内为非重症监护环境中安全有效的血糖控制建立一个新的基准。我们将通过引入血糖控制和用于血糖控制的相关药物的近乎实时的测量来实现这一目标，并利用这些测量来刺激对控制不佳和不遵守机构认可的“最佳实践”治疗方案的患者进行同步干预。这些干预措施包括由血糖控制专家预先授权触发的会诊，向治疗医生发出电子和人工警报，以及向一线提供者实时显示需要改变治疗方案的患者。在干预期间，监测的高血糖和低血糖的住院患者的百分比将与基线表现进行比较。这一衡量和同时干预的战略，称为措施--发明，将在工具包中概述，以协助其他机构实现同样的目标。该工具包将通过医院医学协会和其他基于网络的场所广泛传播，作为涉及各种医疗中心的协作改进工作的中心。 与公共健康相关：我们的目标是建立一个新的基准，使糖尿病和高血糖(高血糖)入院的非重症护理住院患者的血糖值保持在可接受的范围内，并传播一个基于网络的工具包，使全国各地的医疗中心能够达到相同的基准。将使用“措施-预防”战略(对血糖失控患者进行实时测量和识别，及时采取创新干预措施，包括由血糖控制专家预先授权触发会诊和向供应商发出警报)，以加快改进和采用协议驱动的最佳实践方案和顺序集。由于无法控制的高血糖和医源性低血糖(低糖)在医院普遍存在，而且基本上是可以预防的安全问题，与住院时间延长、感染率增加、脱水、电解质紊乱和其他不良后果相关，因此通过可移植到其他医疗中心的方法来减少这些情况的创新将是公共卫生的重大进步。