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基于电子仪表盘的远程血糖管理项目可减少住院成年患者的住院时间和再入院率。

Electronic dashboard-based remote glycemic management program reduces length of stay and readmission rate among hospitalized adults.

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.

Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

出版信息

J Diabetes Investig. 2021 Sep;12(9):1697-1707. doi: 10.1111/jdi.13500. Epub 2021 Feb 20.

Abstract

AIMS/INTRODUCTION: Currently, the impact of hospital-wide glycemic control interventions on length of hospital stay (LOS) and readmission rates are largely unknown. We investigated the impact of a 4-year hospital-wide remote glycemic management program on LOS and 30-day readmission rates among hospitalized adults who received glucose monitoring.

MATERIALS AND METHODS

In this retrospective study, hospitalized patients who received glucose monitoring were classified into groups 1 (high glucose variability), 2 (hypoglycemia), 3 (hyperglycemia) and 4 (relatively stable). The monthly percentage changes, and average monthly percentage changes of hyperglycemia, hypoglycemia and treat to target were determined using joinpoint regression analysis.

RESULTS

A total of 106,528 hospitalized patients (mean age 60.9 ± 18.5 years, 57% men) were enrolled. We observed a significant reduction in the percentage of inpatients in poor glycemic control groups (groups 1, 2 and 3, all P < 0.001), and a reciprocal increase in the relatively stable group (group 4) from 2016 to 2019. We found a significant reduction in LOS by 11.4% (10.5-9.3 days, P = 0.002, after adjustment for age, sex, and admission department). The 30-day readmission rate decreased from 29.9% to 29.3%, mainly among those in group 4 in 2019 (P < 0.001 after adjustment of sex, age, admission department and LOS).

CONCLUSIONS

Improved glycemic control through a hospital-wide electronic remote glycemic management system reduced LOS and 30-day readmission rates. Findings observed in this study might be associated with the reduction in cost of avoidable hospitalizations.

摘要

目的/引言:目前,尚不清楚全院血糖控制干预对住院时间(LOS)和再入院率的影响。我们调查了一项为期 4 年的全院远程血糖管理计划对接受血糖监测的住院成人 LOS 和 30 天再入院率的影响。

材料与方法

在这项回顾性研究中,将接受血糖监测的住院患者分为高血糖波动组 1(high glucose variability)、低血糖组 2(hypoglycemia)、高血糖组 3(hyperglycemia)和血糖相对稳定组 4(relatively stable)。使用 joinpoint 回归分析确定高血糖、低血糖和达标治疗的每月百分比变化和平均每月百分比变化。

结果

共纳入 106528 例住院患者(平均年龄 60.9±18.5 岁,57%为男性)。我们观察到,血糖控制较差的患者比例(组 1、2 和 3,均 P<0.001)显著降低,而血糖相对稳定组(组 4)从 2016 年到 2019 年则呈上升趋势。我们发现 LOS 显著缩短 11.4%(10.5-9.3 天,P=0.002,校正年龄、性别和入院科室后)。30 天再入院率从 29.9%降至 29.3%,主要是由于 2019 年组 4 患者(校正性别、年龄、入院科室和 LOS 后 P<0.001)。

结论

通过全院电子远程血糖管理系统改善血糖控制可降低 LOS 和 30 天再入院率。本研究观察到的结果可能与避免住院的费用降低有关。

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