Ambulatory Services, Medical University of South Carolina, Charleston, SC, USA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Diabetes Sci Technol. 2021 Jul;15(4):733-740. doi: 10.1177/19322968211008513. Epub 2021 Apr 21.
Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown.
This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated.
Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 ( = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period.
In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.
接受抗高血糖药物治疗的住院患者发生低血糖的风险增加。院内低血糖可能导致发病率、死亡率增加，住院时间延长，出院后 30 天内再次入院，这反过来又可能导致成本增加。众所周知，针对低血糖的全院范围的举措是有益的；然而，它们对社区非教学医院的患者护理和经济措施的影响尚不清楚。
这项回顾性质量改进研究调查了 2016 年 1 月 1 日至 2019 年 9 月 30 日期间，在社区医院环境中，全院范围的低血糖干预措施对胰岛素诱导性低血糖发生率的影响。已经计算了潜在的护理成本节约。
在 49315 个总患者日中，有 2682 个患者日发生低血糖（5.4%）。低血糖患者的平均 ± SD 患者日/月为 59.6 ± 16.0。低血糖的频率从 2016 年 1 月的 7.5%显著下降到 2019 年 9 月的 3.9%（ =.001）。2 型糖尿病患者的低血糖发生率显著下降（从 7.4%降至 3.8%；<.0001），而 1 型糖尿病患者的低血糖发生率呈下降趋势，但未达到统计学意义（从 18.5%降至 18.0%；=0.08）。基于低血糖发生率的降低，该医院在研究期间估计有 98635 美元的护理成本节约。
在社区医院环境中，实施针对低血糖的全院范围的举措导致胰岛素诱导性低血糖的发生率显著且持续下降。这些高杠杆风险降低策略可能转化为相当大的成本节约，并可在其他社区医院实施。
