Implementation and Evaluation of a Real-Time Informatics Alert to Prevent Insulin-Associated Hypoglycemia in the Hospital

项目总结/摘要_I_TH__ Nestoras Mathioudakis，医学博士MHS，是内分泌学，糖尿病， 约翰霍普金斯大学的代谢研究所。Mathioudakis博士寻求指导以患者为导向的研究 职业发展奖，以获得技能，知识和指导的研究经验， 作为住院血糖管理领域的临床科学家，这是必不可少的。这项建议是 旨在减少住院患者中由于胰岛素治疗引起的低血糖而造成的可预防的伤害。 胰岛素占住院患者低血糖事件的绝大多数，促使联合国 委员会和安全药物实践研究所将其指定为“高度警戒”药物。事实上， 降糖药物在医院不良事件发生率最高的药物中排名第一。一 胰岛素相关性低血糖的常见原因是“治疗惰性”-未能减少或改变胰岛素， 血糖呈下降趋势的患者。本提案的目的是应用安全 管理原则，从高可靠性组织，如商业航空，以减少可预防的 非危重住院患者胰岛素相关低血糖的危害。 本研究计划的具体目标是：1）建立胰岛素相关性糖尿病的预测模型。 低血糖，2）使用利益相关者参与并基于临床 实践指南，用于有胰岛素相关低血糖风险的患者，以及3）评价 实时信息警报在预防胰岛素相关低血糖症中有效性。 对于目标1，我们提出了一项回顾性研究，使用一个大型医院数据集， 药理学和实验室数据，以开发和验证胰岛素相关的预测模型。 低血糖对于目标2，我们提出了一项采用定性研究方法的前瞻性观察研究， 根据关键利益攸关方的投入，编制实时信息学警报。对于目标3，我们提出了一个中断的 时间序列（前/后）研究设计，以评价实时信息学警报是否降低以下事件的发生率 胰岛素相关性低血糖超过12个月。 授予期间的目标包括开发设计，性能，分析和 通过指导研究，教学课程和正式培训介绍临床研究， 医疗分析。长期职业目标包括发展独立调查员的职业生涯 研究健康信息技术（IT）策略，以改善住院患者的血糖控制， 糖尿病门诊人群。拟议的研究旨在为发展提供新的见解 信息学警报的过程及其在预防胰岛素相关低血糖中的有效性 医院，这与患者的临床结局较差相关。这项工作将为今后的工作奠定基础。 一项旨在评估健康信息技术在住院和门诊患者中针对血糖结果的作用的研究 糖尿病患者。

PROJECT SUMMARY/ABSTRACT_I_TH_______________________ Nestoras Mathioudakis, MD MHS, is an Assistant Professor in the Division of Endocrinology, Diabetes, and Metabolism at Johns Hopkins University. Dr. Mathioudakis seeks a Mentored Patient-Oriented Research Career Development Award in order to obtain the skills, knowledge, and mentored research experience that are essential for a career as a clinician scientist in the field of inpatient glycemic management. This proposal is aimed at reducing preventable harm due to hypoglycemia from insulin treatment among hospitalized patients. Insulin accounts for the vast majority of hypoglycemic events among hospitalized patients, prompting the Joint Commission and the Institute for Safe Medication Practices to designate it a “high alert” medication. In fact, glucose-lowering medications rank first among drugs with the highest rates of adverse events in the hospital. A common cause of insulin-associated hypoglycemia is “therapeutic inertia”—failure to reduce or modify insulin in patients with downward trending blood glucose. The objectives of this proposal are to apply the safety management principles from high reliability organizations, such as commercial aviation, to reduce preventable harm from insulin-associated hypoglycemia in non-critically ill hospitalized patients. The specific aims of this research proposal are to: 1) develop a prediction model for insulin-associated hypoglycemia, 2) develop a real-time informatics alert, using stakeholder engagement and based on clinical practice guidelines, for patients at risk of incident insulin-associated hypoglycemia, and 3) evaluate the effectiveness of a real-time informatics alert in prevention insulin-associated hypoglycemia. For Aim 1, we propose a retrospective study using a large hospital dataset containing clinical, pharmacological, and laboratory data to develop and validate a prediction model for insulin-associated hypoglycemia. For Aim 2, we propose a prospective observational study using qualitative research methods to develop the real-time informatics alerts based on key stakeholder input. For Aim 3, we propose an interrupted time-series (before/after) study design to evaluate whether a real-time informatics alert reduces the incidence of insulin-associated hypoglycemia over a 12-month time period. The goals during the award period include developing expertise in the design, performance, analysis and presentation of clinical research through mentored research, didactic coursework, and formal training in healthcare analytics. Long-term career goals include developing a career as an independent investigator examining health information technology (IT) strategies to improve glycemic control among hospitalized and ambulatory populations with diabetes. The proposed research aims to provide new insights into the development process of informatics alerts and their effectiveness in preventing insulin-associated hypoglycemia in the hospital, which is associated with poor clinical outcomes for patients. This work will lay the foundation for future research to evaluate the role of health IT in targeting glycemic outcomes in both hospitalized and ambulatory patients with diabetes.