Leon Catherine, Crowley Clare, Hogan Helen, Jani Yogini H
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Reading School of Pharmacy, University of Reading, Reading, UK.
Diabet Med. 2025 Oct;42(10):e70101. doi: 10.1111/dme.70101. Epub 2025 Jul 22.
When people who use insulin for Type 2 diabetes have a hospital admission and discharge, they are at risk of harm from incorrect, delayed, or missed insulin doses. Leading indicators can highlight potential areas of risk, providing opportunities to improve safety. Modelling the complex transfer of care pathway can provide insight into where leading indicators could be targeted to support improved outcomes.
Multiple qualitative methods were used, and a framework approach was applied to identify activities (termed functions) involved in managing insulin during the transfer of care, and how factors involving people, equipment and environments (local, organisational and external) impacted these. The Functional Resilience Analysis Method was used to map the transfer of care pathway, and key areas of variability were identified. These areas of variability and two example functions were validated and discussed with key/representative stakeholders in an online seminar.
A total of 59 functions were mapped, and 21 were identified as key functions for potential new measures. These 21 functions were validated at a seminar, and two example functions, empowering people with diabetes who use insulin to manage their diabetes and arranging self-administration of insulin in hospital, were discussed in detail. A selection of potential measures was identified.
Many potential areas for new leading indicators were identified, and examples of potential measures were described. A coproduction approach is required to expand, define and validate these. Such measures provide an opportunity for proactively improving insulin safety during care transfers.
2型糖尿病患者在住院和出院时，存在胰岛素剂量错误、延迟或遗漏而导致伤害的风险。领先指标能够突出潜在的风险领域，为改善安全性提供机会。对复杂的护理路径转移进行建模，可以深入了解领先指标可针对哪些方面以支持改善结果。
采用多种定性方法，并应用框架方法来确定在护理转移期间管理胰岛素所涉及的活动（称为功能），以及涉及人员、设备和环境（本地、组织和外部）的因素如何影响这些活动。使用功能恢复力分析方法绘制护理路径转移图，并确定关键的变异区域。在一次在线研讨会上，与关键/代表性利益相关者对这些变异区域和两个示例功能进行了验证和讨论。
总共绘制了59项功能，其中21项被确定为可能采取新措施的关键功能。这21项功能在研讨会上得到了验证，并详细讨论了两个示例功能，即增强使用胰岛素的糖尿病患者自我管理糖尿病的能力以及安排患者在医院自行注射胰岛素。确定了一系列潜在措施。
确定了许多新领先指标的潜在领域，并描述了潜在措施的示例。需要采用共同生产方法来扩展、定义和验证这些指标。此类措施为在护理转移期间主动改善胰岛素安全性提供了机会。
