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

项目摘要 相当多的患者在一生中患上2型糖尿病(DM)，需要糖尿病 药物。然而，血糖控制不佳(低(低)和高(高)血糖或血糖)从 众所周知，不安全的用药会导致并发症和死亡率。因此，向DM保证 患者在高危时期(如出院)后适当控制血糖的能力是 危急时刻。在之前的一项研究中，我们确定了糖尿病患者出院过程中的高风险失败，包括 糖尿病教育理解的差异性和规范性。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，具有集成的 住院和门诊使用的网站和应用程序，采用以用户为中心的设计方法。的目标是 这项建议是为了整合和实施糖尿病出院工具包，以提高糖尿病患者的质量和安全性 新开胰岛素患者从医院到家庭的糖尿病护理过渡。然后，我们将评估 充分执行以确保过渡时期护理中拟议干预措施的适当忠诚度 布景。随后，我们将进行干预的随机对照试验，以测试 并评估其对减少出院后高血糖和低血糖的影响。然后我们 建议传播我们的调查结果，以便今后在我们整个机构和地方一级使用该工具包 通过与我们的糖尿病协会的当地合作。在DM方面显然需要改进 过渡护理，改善糖尿病药物的安全使用，因为它们是高风险的 人口。该干预有可能被推广到其他护理环境中的DM护理(例如， 急诊科、门诊部)为糖尿病患者服务。

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.