Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA.
Division of Hospital Medicine, Johns Hopkins Community Physicians at Howard County General Hospital, Columbia, MD, USA.
J Diabetes Sci Technol. 2024 Jul;18(4):866-873. doi: 10.1177/19322968231153883. Epub 2023 Feb 14.
The American Diabetes Association (ADA) recommends measuring A1c in all inpatients with diabetes if not performed in the prior three months. Our objective was to determine the impact of utilizing Lean Six Sigma to increase the frequency of A1c measurements in hospitalized patients.
We evaluated inpatients with diabetes mellitus consecutively admitted in a community hospital between January 2016 and June 2021, excluding those who had an A1c in the electronic health record (EHR) in the previous three months. Lean Six Sigma was utilized to define the extent of the problem and devise solutions. The intervention bundle delivered between November 2017 and February 2018 included (1) provider education on the utility of A1c, (2) more rapid turnaround of A1c results, and (3) an EHR glucose-management tab and insulin order set that included A1c. Hospital encounter and patient-level data were extracted from the EHR via bulk query. Frequency of A1c measurement was compared before (January 2016-November 2017) and after the intervention (March 2018-June 2021) using χ analysis.
Demographics did not differ preintervention versus postintervention (mean age [range]: 70.9 [18-104] years, sex: 52.2% male, race: 57.0% white). A1c measurements significantly increased following implementation of the intervention bundle (61.2% vs 74.5%, < .001). This level was sustained for more than two years following the initial intervention. Patients seen by the diabetes consult service (40.4% vs 51.7%, P < 0.001) and length of stay (mean: 135 hours vs 149 hours, P < 0.001) both increased postintervention.
We demonstrate a novel approach in improving A1c in hospitalized patients. Lean Six Sigma may represent a valuable methodology for community hospitals to improve inpatient diabetes care.
美国糖尿病协会（ADA）建议对所有住院的糖尿病患者进行 A1c 检测，如果在过去三个月内未进行过检测。我们的目标是确定利用精益六西格玛来提高住院患者 A1c 检测频率的效果。
我们对 2016 年 1 月至 2021 年 6 月期间连续入住社区医院的糖尿病住院患者进行了评估，排除了过去三个月内电子健康记录（EHR）中有 A1c 的患者。利用精益六西格玛来确定问题的严重程度并制定解决方案。2017 年 11 月至 2018 年 2 月期间实施的干预措施包括：（1）对医生进行 A1c 应用价值的教育，（2）更快地获得 A1c 结果，以及（3）在 EHR 中添加血糖管理标签和胰岛素医嘱集，其中包括 A1c。通过批量查询从 EHR 中提取医院和患者层面的数据。采用 χ ²检验比较干预前后（2016 年 1 月至 2017 年 11 月和 2018 年 3 月至 2021 年 6 月）的 A1c 检测频率。
干预前后患者的人口统计学特征无差异（平均年龄[范围]：70.9 [18-104]岁，男性占 52.2%，白种人占 57.0%）。实施干预措施后，A1c 检测明显增加（61.2%对 74.5%，<.001）。这种水平在初始干预后持续了两年多。接受糖尿病咨询服务的患者（40.4%对 51.7%，P<.001）和住院时间（平均：135 小时对 149 小时，P<.001）均增加。
我们证明了一种提高住院患者 A1c 的新方法。精益六西格玛可能是社区医院改善住院糖尿病患者护理的一种有价值的方法。
