Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Diabetes Technol Ther. 2012 Jul;14(7):610-8. doi: 10.1089/dia.2011.0258. Epub 2012 Apr 23.
Poorly controlled diabetes in hospitalized patients is associated with poor clinical outcomes. We hypothesized that computer-based diabetes training could improve house staff knowledge and comfort for the management of diabetes in a large tertiary-care hospital.
We implemented a computer-based training program on inpatient diabetes for internal medicine house staff at the Brigham and Women's Hospital (Boston, MA) in September 2009. House staff were required to complete the program and answer a set of questions, before and after the program, to evaluate their level of comfort and knowledge of inpatient diabetes. Chart reviews of all non-critically ill patients with diabetes managed by house staff in August 2009 (before the program) and December 2009 (after the program) were performed. Chart reviews were also performed for August 2008 and December 2008 to compare house staff management practices when the computer-based educational program was not available.
A significant increase in comfort levels and knowledge in the management of inpatient diabetes was seen among house staff at all levels of training (P<0.02), but the increase was smaller for senior house staff compared with junior house staff. Nonsignificant trends suggesting increased use of basal-bolus insulin (P=0.06) and decreased use of sliding-scale insulin (P=0.10) were seen following the educational intervention in 2009, whereas no such change was seen in 2008 (P>0.90). Overall, house staff evaluated the training program as "very relevant" and the technology interface as "good."
A computer-based diabetes training program can improve the comfort and knowledge of house staff and potentially improve their insulin administration practices at large academic centers.
住院患者血糖控制不佳与临床结局不良相关。我们假设基于计算机的糖尿病培训可以提高住院医师在大型三级保健医院管理糖尿病的知识和舒适度。
我们于 2009 年 9 月在马萨诸塞州波士顿的布莱根妇女医院（Brigham and Women's Hospital）为内科住院医师实施了一项基于计算机的住院糖尿病培训计划。住院医师在参加该计划之前和之后都需要完成该计划并回答一组问题，以评估他们对住院糖尿病的舒适度和知识水平。对 2009 年 8 月（在该计划之前）和 2009 年 12 月（在该计划之后）由住院医师管理的所有非危重症糖尿病患者的病历进行了回顾。还对 2008 年 8 月和 2008 年 12 月的病历进行了回顾，以比较在没有基于计算机的教育计划时住院医师的管理做法。
各级培训的住院医师在管理住院糖尿病的舒适度和知识水平方面均显著提高（P<0.02），但与初级住院医师相比，高级住院医师的提高幅度较小。虽然在 2009 年的教育干预后，使用基础-餐时胰岛素的趋势略有增加（P=0.06），使用胰岛素推注的趋势略有减少（P=0.10），但在 2008 年没有观察到这种变化（P>0.90）。总体而言，住院医师认为培训计划“非常相关”，技术界面“良好”。
基于计算机的糖尿病培训计划可以提高住院医师的舒适度和知识水平，并有可能改善他们在大型学术中心的胰岛素给药实践。
