Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Neubauer, K.
Glycaemic Management with a Clinical Decision Support System in the Hospital Setting. Quality analysis – Algorithm development– Evaluation of a computerised system
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2016. pp.
[OPEN ACCESS]
FullText
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Pieber Thomas
- Schaupp Lukas
- Altmetrics:
- Abstract:
- Hyperglycaemia is a complex and highly prevalent phenomenon in hospitals that has to be adequately treated by implementing standardised and evidence-based strategies. The overall aims of this doctoral thesis are to determine the quality of glycaemic management and to develop and evaluate a computerised workflow and decision support system for patients with type 2 diabetes in the hospital. The aims are the focus of seven studies. In Study 1 the quality of glycaemic management in 50 patients at two general wards was assessed retrospectively. The quality analysis of glycaemic management demonstrated considerable effort, but also a lack of translation into an adequate insulin therapy. This gap in glycaemic management could be closed by implementing a basal-bolus insulin algorithm. In Study 2, glycaemic control and usability of a paper-based algorithm for basal-bolus insulin therapy were evaluated to develop a decision support system. In this ward-controlled study, 74 patients with diabetes were assigned to either algorithm driven therapy or standard care. Mean BG values in the algorithm group were significantly reduced from 204 ± 65 (baseline) to 148 ± 32 mg/dl (last 24 hours) (P<0.001). The algorithm group had a significantly higher percentage of BG values in the range 70-180 mg/dl compared to the standard group (73% vs. 53%, P<0.001). These results supported the implementation of the algorithm in a computerised decision support system. The aim of the feasibility Study 3 was to evaluate the efficacy, safety and usability of the computerised algorithm in 30 patients. GlucoTab provided automated workflow and insulin dosing support to nurses and physicians. The results supported the implementation of GlucoTab at other hospital wards. The aim of the non-controlled Study 4 was to investigate efficacy, safety and usability of the GlucoTab system in 99 patients with diabetes at different wards. Percentage of BG measurements from 70-140 mg/dl occurred in 50.2% of all measurements. BG measurements <70 mg/dl occurred in 1.9%. Adherence to insulin dosing suggestions was high (96.5% bolus, 96.7% basal). Based on the efficacious, safe and user-accepted implementation, the GlucoTab was CE marked as a medical device which allowed the use in routine care. GlucoTab was implemented at three hospital wards. The use of GlucoTab in routine care was evaluated in 92 patients in Study 5 according to MPG §40(5). Results of Study 4 concerning efficacy and safety were confirmed. The routine use of GlucoTab during a patient’s hospital stay demonstrated that decision and documentation support systems for alternative therapy types are needed. The analysis of pooled patient data in Study 6 aimed to investigate efficacy and safety of GlucoTab in 97 adult (<70 years) and 94 geriatric (=70 years) patients. Insulin therapy was started with a total daily dose (TDD) of 0.5 units per kg bodyweight in adult patients and 0.3 units per kg bodyweight in geriatric patients. The insulin starting dose supported an efficacious and safe glycaemic control in both age groups. The aim of Study 7 was to develop a comprehensive concept for insulin therapy adjustments by nurses including workflow simplifications and how to react in critical situations. The Austrian Federal Ministry of Health stated that insulin adjustment by nurses is permitted under certain conditions which will be implemented into the GlucoTab feature insulin adjustment by nurses. For the first time it is now legally allowed that nurses adjust insulin therapy when supported by technology. Within this doctoral thesis, the development and evaluation of GlucoTab was a starting point to improve glycaemic management in the hospital. Ongoing projects show that there are a lot of possibilities to further improve glycaemic management and patient outcomes.