Innovations Reducing Hyper-and Hypo-glycemic events in Inpatients

描述（由申请人提供）：不受控制的高血糖（高血糖水平）和医源性低血糖（低血糖水平）是医院中公认和普遍存在的安全问题，无论是糖尿病患者还是非糖尿病患者。这些基本上可以预防的疾病与住院时间延长、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欠佳的住院患者出院后很久才制定的，因此安全有效的血糖控制方案仍未得到充分利用。我们的目标是建立一个新的基准安全有效的血糖控制在非重症监护环境超过两年的时间。我们将通过引入近实时的血糖控制测量和用于血糖控制的相关药物来实现这一目标，并使用这些测量来刺激对控制不良和不遵守制度认可的“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的触发咨询，向治疗医生发出电子和人工警报，以及向一线医护人员实时显示需要改变治疗方案的患者。在干预期间，监测的住院患者中不受控制的高血糖和低血糖的百分比将与基线表现进行比较。这种测量和同时干预的策略，称为测量-干预，将在工具包中概述，以帮助其他机构实现相同的目标。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核心。

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.