Society of hospital medicine glycemic control task force summary: Practical recommendations for assessing the impact of glycemic control efforts

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Abstract

5 University of California San Diego, Division of Hospital Medicine, Department of Medicine, San Diego, California D ata collection, analysis, and presentation are key to the success of any hospital glycemic control initiative. Such efforts enable the management team to track improvements in processes and outcomes, make necessary changes to their quality improvement efforts, justify the provision of necessary time and resources, and share their results with others. Reliable metrics for assessing glycemic control and frequency of hypoglycemia are essential to accomplish these tasks and to assess whether interventions result in more benefit than harm. Hypoglycemia metrics must be especially convincing because fear of hypoglycemia remains a major source of clinical inertia, impeding efforts to improve glucose control. Currently, there are no official standards or guidelines for formulating metrics on the quality of inpatient glycemic control. This creates several problems. First, different metrics vary in their biases and in their responsiveness to change. Thus, use of a poor metric could lead to either a falsely positive or falsely negative impression that a quality improvement intervention is in fact improving glycemic control. Second, the proliferation of different measures and analytical plans in the research and quality improvement literature make it very difficult for hospitals to compare baseline performance, determine need for improvement, and understand which interventionsmay bemost effective. A related article in this supplement provides the rationale for improved inpatient glycemic control. That article argues that the current state of inpatient glycemic control, with the frequent occurrence of severe hyperglycemia and irrational insulin ordering, cannot be considered acceptable, especially given the large body of data (albeit largely observational) linking hyperglycemia to negative patient outcomes. However, regardless of whether one is an advocate or skeptic of tighter glucose control in the intensive care unit (ICU) and especially the non-ICU setting, there is no question that standardized, valid, and reliable metrics are needed to compare efforts to improve glycemic control, better understand whether such control actually improves patient care, and closely monitor patient safety. This article provides a summary of practical suggestions to assess glycemic control, insulin use patterns, and safety (hypoglycemia and severe hyperglycemia). In particular, we discuss the pros and cons of various measurement choices. We conclude with a tiered summary of recommendations for practical metrics No honoraria were paid to any authors for time and expertise spent on the writing of this article.

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