Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Hospitalist Program, Department of Family Medicine, Alberta Health Services-Calgary Zone, Calgary, Alberta, Canada.
Can J Diabetes. 2018 Oct;42(5):505-513.e1. doi: 10.1016/j.jcjd.2017.12.010. Epub 2017 Dec 27.
To develop and evaluate a Basal Bolus Insulin Therapy (BBIT) Knowledge Translation toolkit to address barriers to adoption of established best practice with BBIT in the care of adult inpatients.
This study was conducted in 2 phases and focused on the hospitalist provider group across 4 acute care facilities in Calgary. Phase 1 involved a qualitative evaluation of provider and site specific barriers and facilitators, which were mapped to validated interventions using behaviour change theory. This informed the co-development and optimization of the BBIT Knowledge Translation toolkit, with each tool targeting a specific barrier to improved diabetes care practice, including BBIT ordering. In Phase 2, the BBIT Knowledge Translation toolkit was implemented and evaluated, focusing on BBIT ordering frequency, as well as secondary outcomes of hyperglycemia (patient-days with BG >14.0 mmol/L), hypoglycemia (patient-days with BG <4.0 mmol/L), and acute length of stay.
Implementation of the BBIT Knowledge Translation toolkit resulted in a significant 13% absolute increase in BBIT ordering. Hyperglycemic patient-days were significantly reduced, with no increase in hypoglycemia. There was a significant, absolute 14% reduction in length of stay.
The implementation of an evidence-informed, multifaceted BBIT Knowledge Translation toolkit effectively reduced a deeply entrenched in-patient diabetes care gap. The resulting sustained practice change improved patient clinical and system resource utilization outcomes. This systemic approach to implementation will guide further scale and spread of glycemic optimization initiatives.
开发并评估基础-餐时胰岛素治疗（BBIT）知识转化工具包，以解决在成人住院患者护理中采用既定最佳实践的 BBIT 时所面临的障碍。
本研究分两个阶段进行，重点关注卡尔加里 4 家急性护理机构的医院医生服务提供者群体。第 1 阶段涉及对提供者和特定地点的障碍和促进因素进行定性评估，这些障碍和促进因素通过行为改变理论与经过验证的干预措施相关联。这为 BBIT 知识转化工具包的共同开发和优化提供了信息，每个工具都针对改善糖尿病护理实践的特定障碍，包括 BBIT 开单。在第 2 阶段，实施并评估了 BBIT 知识转化工具包，重点关注 BBIT 开单的频率，以及血糖过高（BG>14.0mmol/L 的患者天数）、低血糖（BG<4.0mmol/L 的患者天数）和急性住院时间的次要结果。
实施 BBIT 知识转化工具包后，BBIT 开单的绝对数量增加了 13%。高血糖患者天数显著减少，而低血糖患者天数没有增加。住院时间绝对减少了 14%。
实施循证、多方面的 BBIT 知识转化工具包有效地缩小了根深蒂固的住院患者糖尿病护理差距。由此产生的持续实践改变改善了患者的临床和系统资源利用结果。这种系统的实施方法将指导进一步扩大血糖优化计划的规模和传播。
