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Tytuł pozycji:

Personalized diabetes management recommendations at hospital discharge based on a computerized, pre-hospitalization clinical profile analysis: A prospective, electronic health records-based study.

Tytuł :
Personalized diabetes management recommendations at hospital discharge based on a computerized, pre-hospitalization clinical profile analysis: A prospective, electronic health records-based study.
Autorzy :
Wasserstrum Y; Department of Medicine T, Chaim Sheba Medical Center, Ramat Gan, Israel.; Chaim Sheba General Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Peles-Bortz A; Hospital Management, Chaim Sheba Medical Center, Ramat Gan, Israel.; Chaim Sheba General Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Dabahi S; Institute of Endocrinology, Chaim Sheba Medical Center, Ramat Gan, Israel.; Chaim Sheba General Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Gringauz I; Department of Medicine T, Chaim Sheba Medical Center, Ramat Gan, Israel.; Chaim Sheba General Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Tirosh A; Institute of Endocrinology, Chaim Sheba Medical Center, Ramat Gan, Israel.; Chaim Sheba General Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Zimlichman E; Hospital Management, Chaim Sheba Medical Center, Ramat Gan, Israel.; Chaim Sheba General Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Segal G; Department of Medicine T, Chaim Sheba Medical Center, Ramat Gan, Israel.; Chaim Sheba General Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel.; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Źródło :
The International journal of health planning and management [Int J Health Plann Manage] 2019 Oct; Vol. 34 (4), pp. e1854-e1861. Date of Electronic Publication: 2019 Sep 15.
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Original Publication: Chichester, Sussex, England : Wiley, c1985-
MeSH Terms :
Electronic Health Records*/statistics & numerical data
Patient Discharge Summaries*
Diabetes Mellitus, Type 2/*therapy
Precision Medicine/*methods
Aged ; Algorithms ; Female ; Glycated Hemoglobin A/analysis ; Humans ; Male ; Patient Discharge ; Prospective Studies
References :
American Diabetes Association. Standards of medical care in diabetes: 6. Glycemic targets. Diabetes Care. 2017;40(Supplement 1):S48-S56.
Rydén L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34(39):3035-3087.
Jiang HJ, Stryer D, Friedman B, Andrews R. Multiple hospitalizations for patients with diabetes. Diabetes Care. 2003;26(5):1421-1426.
American Diabetes Association. Standards of medical care in diabetes: 14. Diabetes care in the hospital. Diabetes Care. 2017;40(Supplement 1).
Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jan;97(1):16-38.
Tricco AC, Ivers NM, Grimshaw JM, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet. 2012;379(9833):2252-2261.
Umpierrez GE, Reyes D, Smiley D, et al. Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes. Diabetes Care. 2014;37(11):2934-2939.
Ali MK, Singh K, Kondal D, et al. Effectiveness of a multicomponent quality improvement strategy to improve achievement of diabetes care goals. Ann Intern Med. 2016;165(6):399-408.
Kucher N, Koo S, Quiroz R, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med. 2005 Mar 10 [cited 2017 Jan 15;352(10):969-977. Available from. http://www.ncbi.nlm.nih.gov/pubmed/15758007.
Ancker JS, Kern LM, Edwards A, et al. Associations between healthcare quality and use of electronic health record functions in ambulatory care. J Am Med Inform Assoc [Internet. 2015 Jul [cited 2017 Jan 15;22(4):864-871. Available from. http://www.ncbi.nlm.nih.gov/pubmed/25896648.
Doyle M-A, Malcolm JC, Liu D, Maranger J, Ooi TC, Keely E. Using a structured discharge letter template to improve communication during the transition from a specialized outpatient diabetes clinic to a primary care physician. Can J diabetes. 2015 Dec [cited 2016 Dec 26;39(6):457-466. Available from. http://www.ncbi.nlm.nih.gov/pubmed/26454683.
Pérez A, Reales P, Barahona MJ, Romero MG, Miñambres I. Efficacy and feasibility of basal-bolus insulin regimens and a discharge-strategy in hospitalised patients with type 2 diabetes-the HOSMIDIA study. Int J Clin Pract. 2014 Oct [cited 2016 Dec 26;68(10):1264-1271. Available from. http://www.ncbi.nlm.nih.gov/pubmed/25269951.
Contributed Indexing :
Keywords: diabetes; discharge recommendation; electronic health record; glycosylated hemoglobin; quality measures
Substance Nomenclature :
0 (Glycated Hemoglobin A)
0 (hemoglobin A1c protein, human)
Entry Date(s) :
Date Created: 20190917 Date Completed: 20200513 Latest Revision: 20200513
Update Code :
20201023
DOI :
10.1002/hpm.2906
PMID :
31523844
Czasopismo naukowe
Background: While glycemic control of hospitalized diabetic patients is straightforward, personalization of management at discharge is challenging. Treatment guidelines base recommendations on the clinical profile of patients. We checked the feasibility of implementing discharge recommendations, based on the clinical profile in the patients' electronic health records (EHR).
Methods: A decision-making algorithm was devised according to current guidelines. It was incorporated into the EHR. A prospective follow-up of eligible diabetes patients was done.
Results: During 15 months, 835 patients (HbA1c was 6.9% [6.2%-7.8%]) met our inclusion criteria. The rate of HbA1c acquisition increased from 55% during Q1 to 85%, 86%, 88%, and 87% thereafter. Also, the rate of incorporating personalized management recommendations to discharge letters increased: from 14.9% during Q1 to 42.9%, 43.0%, 47.2%, and 53.4% thereafter. Fifty-eight (17.3%) of patients who got personalized recommendations upon discharge were found to have HbA1c values that were over 1% deviating from suggested target HbA1c. They got the most stringent recommendations. Twenty-nine (50%) of them had available follow-up HbA1c values showing a significant drop in HbA1c: from 9.1% (8.4%-10.2%) to 8.5% (7.4%-9.5%), P = .03.
Conclusions: Personalized, EHR algorithm-based, management recommendations for diabetes upon discharge from hospitalization are feasible and beneficial.
(© 2019 John Wiley & Sons, Ltd.)
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