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针对血糖控制不佳的住院患者的糖尿病专项电子出院医嘱集及出院后护理支持的有效性:随机对照试验

Effectiveness of a Diabetes-Focused Electronic Discharge Order Set and Postdischarge Nursing Support Among Poorly Controlled Hospitalized Patients: Randomized Controlled Trial.

作者信息

White Audrey, Bradley David, Buschur Elizabeth, Harris Cara, LaFleur Jacob, Pennell Michael, Soliman Adam, Wyne Kathleen, Dungan Kathleen

机构信息

Internal Medicine, University of Virginia, Charlottesville, VA, United States.

Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, United States.

出版信息

JMIR Diabetes. 2022 Jul 26;7(3):e33401. doi: 10.2196/33401.

Abstract

BACKGROUND

Although the use of electronic order sets has become standard practice for inpatient diabetes management, there is limited decision support at discharge.

OBJECTIVE

In this study, we assessed whether an electronic discharge order set (DOS) plus nurse follow-up calls improve discharge orders and postdischarge outcomes among hospitalized patients with type 2 diabetes mellitus.

METHODS

This was a randomized, open-label, single center study that compared an electronic DOS and nurse phone calls to enhanced standard care (ESC) in hospitalized insulin-requiring patients with type 2 diabetes mellitus. The primary outcome was change in glycated hemoglobin (HbA) level at 24 weeks after discharge. The secondary outcomes included the completeness and accuracy of discharge prescriptions related to diabetes.

RESULTS

This study was stopped early because of feasibility concerns related to the long-term follow-up. However, 158 participants were enrolled (DOS: n=82; ESC: n=76), of whom 155 had discharge data. The DOS group had a greater frequency of prescriptions for bolus insulin (78% vs 44%; P=.01), needles or syringes (95% vs 63%; P=.03), and glucometers (86% vs 36%; P<.001). The clarity of the orders was similar. HbA data were available for 54 participants in each arm at 12 weeks and for 44 and 45 participants in the DOS and ESC arms, respectively, at 24 weeks. The unadjusted difference in change in HbA level (DOS - ESC) was -0.6% (SD 0.4%; P=.18) at 12 weeks and -1.1% (SD 0.4%; P=.01) at 24 weeks. The adjusted difference in change in HbA level was -0.5% (SD 0.4%; P=.20) at 12 weeks and -0.7% (SD 0.4%; P=.09) at 24 weeks. The achievement of the individualized HbA target was greater in the DOS group at 12 weeks but not at 24 weeks.

CONCLUSIONS

An intervention that included a DOS plus a postdischarge nurse phone call resulted in more complete discharge prescriptions. The assessment of postdischarge outcomes was limited, owing to the loss of the long-term follow-up, but it suggested a possible benefit in glucose control.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03455985; https://clinicaltrials.gov/ct2/show/NCT03455985.

摘要

背景

尽管使用电子医嘱集已成为住院糖尿病管理的标准做法,但出院时的决策支持有限。

目的

在本研究中,我们评估了电子出院医嘱集(DOS)加护士随访电话是否能改善2型糖尿病住院患者的出院医嘱和出院后结局。

方法

这是一项随机、开放标签、单中心研究,比较了电子DOS和护士电话与强化标准护理(ESC)在需要胰岛素治疗的2型糖尿病住院患者中的效果。主要结局是出院后24周糖化血红蛋白(HbA)水平的变化。次要结局包括与糖尿病相关的出院处方的完整性和准确性。

结果

由于与长期随访相关的可行性问题,本研究提前终止。然而,共纳入了158名参与者(DOS组:n = 82;ESC组:n = 76),其中155名有出院数据。DOS组大剂量胰岛素处方的频率更高(78%对44%;P = 0.01),针头或注射器处方的频率更高(95%对63%;P = 0.03),血糖仪处方的频率更高(86%对36%;P < 0.001)。医嘱的清晰度相似。每组各有54名参与者在12周时可获得HbA数据,DOS组和ESC组分别有44名和45名参与者在24周时可获得HbA数据。出院后12周时,HbA水平变化的未调整差异(DOS - ESC)为-0.6%(标准差0.4%;P = 0.18),24周时为-1.1%(标准差0.4%;P = 0.01)。HbA水平变化的调整差异在12周时为-0.5%(标准差0.4%;P = 0.20),24周时为-0.7%(标准差0.4%;P = 0.09)。在12周时,DOS组实现个体化HbA目标的比例更高,但在24周时并非如此。

结论

包括DOS加出院后护士电话的干预措施导致出院处方更完整。由于失去了长期随访,对出院后结局的评估有限,但这表明在血糖控制方面可能有益。

试验注册

ClinicalTrials.gov NCT03455985;https://clinicaltrials.gov/ct2/show/NCT03455985。

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