Implementation and Testing of a Diabetes Discharge Intervention to Improve Safety During Transitions of Care

项目摘要 大量患者在其一生中发展为2型糖尿病（DM）并且需要糖尿病 药物治疗然而，血糖控制不佳（低（低）和高（高）血糖）， 众所周知，不安全的药物使用会导致并发症和死亡。因此，确保DM 患者在高风险时期（如出院）后适当管理血糖控制的能力， 很危险在先前的研究中，我们确定了糖尿病患者出院过程中的高风险失败，包括 糖尿病教育的理解和标准化的差异。为了解决这些问题，我们 开发了糖尿病出院工具包，这是一个为患者和提供者提供的实践教学工具包， 网站和应用程序的住院和门诊使用，利用以用户为中心的设计方法。的目标 该提案旨在整合和实施糖尿病出院工具包，以提高 糖尿病护理从医院到家庭的过渡，为新处方胰岛素的患者。然后我们将评估 实施的充分性，以确保在这一过渡性护理中拟议的干预措施的适当忠实性 设置.接下来，我们将进行一项干预的随机对照试验，以测试 工具包，并评估其对减少出院后高血糖和低血糖的影响。然后我们 我建议在整个机构和地方一级传播我们的调查结果，以便今后使用工具包 通过与当地糖尿病协会的合作。DM明显需要改进 护理的过渡，以及提高DM药物的安全使用，因为它们是高风险的 人口这种干预有可能推广到其他护理环境中的DM护理（例如， 急诊科、门诊部）。

Project Summary A substantial number of patients develop type 2 diabetes mellitus (DM) during their lifetime and need diabetes medications. However, poor glycemic control (hypo (low) - and hyper- (high) glycemia or blood sugar) from unsafe medication use is known to contribute to both complications and mortality. Therefore, assuring DM patients' ability to appropriately manage glycemic control after high risk times, such as hospital discharge, is critical. In a prior study, we identified high risk failures in the discharge process of patients with DM, including variability in comprehension and standardization of diabetes education. To address these failures, we developed a Diabetes Discharge Toolkit, a hands-on teaching kit for patients and providers with an integrated website and app for both inpatient and outpatient use, utilizing a user-centered design approach. The goal of this proposal is to integrate and implement the Diabetes Discharge Toolkit to improve the quality and safety of the transition of DM care from hospital to home for patients newly prescribed insulin. We will then assess the adequacy of implementation to ensure appropriate fidelity of the proposed intervention in this transitional care setting. Following, we will conduct a randomized controlled trial of the intervention to test the efficacy of the Toolkit and to assess its impact on reducing hyper- and hypoglycemia, following hospital discharge. We then propose to disseminate our findings for future use of the Toolkit throughout our institution and at the local level through a local collaboration with our diabetes association. There is a clear need for improvement in DM transitions of care, and improvement in the safe use of DM medications, given that they are a high risk population. This intervention has the potential to be generalized to DM care in other care settings (e.g., emergency department, outpatient clinic) for DM patients.