Karmon E Helmle1, Sunita Chacko2, Trevor Chan2, Alison Drake2, Alun L Edwards3, Glenda E Moore4, Leta C Philp4, Naomi Popeski4, Rhonda L Roedler5, Edwin J R Rogers6, Gabrielle L Zimmermann7, Julie McKeen8. 1. Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: Karmon.helmle@albertahealthservices.ca. 2. Hospitalist Program, Department of Family Medicine, Alberta Health Services-Calgary Zone, Calgary, Alberta, Canada. 3. Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 4. Diabetes, Obesity, and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada. 5. Pharmacy Services, South Health Campus, Alberta Health Services, Calgary, Alberta, Canada. 6. Clinical Analytics, Analytics, Data Integration, Measurement and Reporting (DIMR), Alberta Health Services, Calgary, Alberta, Canada. 7. Knowledge Translation Platform, Alberta SPOR SUPPORT Unit, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 8. Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Diabetes, Obesity, and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada.
Abstract
OBJECTIVES: To develop and evaluate a Basal Bolus Insulin Therapy (BBIT) Knowledge Translation toolkit to address barriers to adoption of established best practice with BBIT in the care of adult inpatients. METHODS: This study was conducted in 2 phases and focused on the hospitalist provider group across 4 acute care facilities in Calgary. Phase 1 involved a qualitative evaluation of provider and site specific barriers and facilitators, which were mapped to validated interventions using behaviour change theory. This informed the co-development and optimization of the BBIT Knowledge Translation toolkit, with each tool targeting a specific barrier to improved diabetes care practice, including BBIT ordering. In Phase 2, the BBIT Knowledge Translation toolkit was implemented and evaluated, focusing on BBIT ordering frequency, as well as secondary outcomes of hyperglycemia (patient-days with BG >14.0 mmol/L), hypoglycemia (patient-days with BG <4.0 mmol/L), and acute length of stay. RESULTS: Implementation of the BBIT Knowledge Translation toolkit resulted in a significant 13% absolute increase in BBIT ordering. Hyperglycemic patient-days were significantly reduced, with no increase in hypoglycemia. There was a significant, absolute 14% reduction in length of stay. CONCLUSIONS: The implementation of an evidence-informed, multifaceted BBIT Knowledge Translation toolkit effectively reduced a deeply entrenched in-patient diabetes care gap. The resulting sustained practice change improved patient clinical and system resource utilization outcomes. This systemic approach to implementation will guide further scale and spread of glycemic optimization initiatives.
OBJECTIVES: To develop and evaluate a Basal Bolus Insulin Therapy (BBIT) Knowledge Translation toolkit to address barriers to adoption of established best practice with BBIT in the care of adult inpatients. METHODS: This study was conducted in 2 phases and focused on the hospitalist provider group across 4 acute care facilities in Calgary. Phase 1 involved a qualitative evaluation of provider and site specific barriers and facilitators, which were mapped to validated interventions using behaviour change theory. This informed the co-development and optimization of the BBIT Knowledge Translation toolkit, with each tool targeting a specific barrier to improved diabetes care practice, including BBIT ordering. In Phase 2, the BBIT Knowledge Translation toolkit was implemented and evaluated, focusing on BBIT ordering frequency, as well as secondary outcomes of hyperglycemia (patient-days with BG >14.0 mmol/L), hypoglycemia (patient-days with BG <4.0 mmol/L), and acute length of stay. RESULTS: Implementation of the BBIT Knowledge Translation toolkit resulted in a significant 13% absolute increase in BBIT ordering. Hyperglycemic patient-days were significantly reduced, with no increase in hypoglycemia. There was a significant, absolute 14% reduction in length of stay. CONCLUSIONS: The implementation of an evidence-informed, multifaceted BBIT Knowledge Translation toolkit effectively reduced a deeply entrenched in-patientdiabetes care gap. The resulting sustained practice change improved patient clinical and system resource utilization outcomes. This systemic approach to implementation will guide further scale and spread of glycemic optimization initiatives.
Authors: Xiaodan Zhang; Tong Zhang; Guangda Xiang; Wenbo Wang; Yanli Li; Tao Du; Yunjuan Zhao; Singla Sethiel Mosha; Wangen Li Journal: BMJ Open Diabetes Res Care Date: 2020-09