Despite the well-known negative impact suboptimal glycemic management has on both patient outcomes and hospital finances, most health systems are not adequately prepared to meet the standard of care patients require. As rates of diabetes continue to climb (REF), it’s more important than ever for health systems to implement a plan to improve inpatient glycemic control. Hospitals must leverage accurate and timely inpatient glucose data, or glucometrics, to inform their decision making and guide transformative quality improvement (QI) initiatives. But with almost 60% of hospitals indicating they do not have automated methods to collect and analyze blood glucose data, it’s no wonder why many insulin management improvement efforts stall.
The Centers for Medicare and Medicaid Services (CMS) recently announced new quality reporting measures relating to severe inpatient hyper- and hypoglycemia. These metrics are designed to spur improvements in glycemic management by highlighting the rates of these preventable patient safety events. The industry is now within the formal reporting period, and it’s likely that many health systems are underprepared for the agency’s new quality measures. For health systems struggling to measure the effectiveness of their inpatient glycemic management program, a key first step is to implement standardized practices for tracking and comparing blood glucose data in the hospital.
Where Are We Now?
In a new paper titled Glucometrics: Where Are We Now? published in Current Diabetes Reports, I worked with national colleagues to portray the state of glucometrics in the hospital setting. We highlight the challenges health systems have historically had to measure success in glycemic management, because of debates on factors that include benchmarks, common key performance indicators or targets, practical definitions and meaningful methods of data analysis. This inability to drive consensus on goals and definitions may have hampered attempts to reduce rates of hyperglycemia. However, national organizations such as The National Quality Foundation (NQF) and National Healthcare Safety Network (NHSN) have helped advance initiatives to develop a standardized reporting system and led efforts to raise awareness of the importance of glycemic management in the hospital.
Standardization of these metrics enables hospitals to evaluate internal systems and processes and compare outside organizations to each other to measure improvement over time. Hospitals aspiring to be patient safety pioneers must leverage the latest reporting Glucometrics to improve patient outcomes and reduce costs.
The Next Evolution of GlucoMetrics®
In support of quality improvement projects, we’ve introduced the latest evolution of GlucoMetricsⓇ to provide advanced glucose data analytics, reporting, dashboards and data visualizations for health systems to receive revolutionary insight into glycemic outcomes. GlucoMetrics allow for the assessment of QI projects and help justify the use of resources for protocols and data comparison, especially critical as health systems prepare for the CMS quality reporting measures. Our latest enhancements to GlucoMetrics empower glycemic management committees, senior leadership, providers and nurses with self-serve access to key performance indicators, trends and benchmarks related to glycemia treatment.
Metrics that Deliver Actionable Insights
Depending on staffing and resources, unique processes, and status of quality improvement projects, there are a wide range of metrics hospitals can look at as they start their journey to making instances of severe hypo- and hyperglycemia never events. To improve patient care at the bedside today, health systems need to prioritize a few top metrics that offer a transparent view into dosing recommendations and rates of hypo- and hyperglycemia. Let’s explore some of the highlights and the benefits they provide.
1. Outcome metrics like hypoglycemia as measured by patient day
The most common goal of inpatient glycemic management programs is to reduce preventable hypoglycemia – an endeavor that has a particular level of urgency due to CMS measures. In order to do this, hospitals must have access to their rates of hypoglycemia, and the best way to track hypoglycemia is via patient-day. Most hospitals use % BG values, which may give a false sense of security in their hypoglycemia rates, since the denominator may be so large. The patient-day metric is more challenging to calculate, but Glytec presents hypoglycemia in various ways, but focuses on using patient-day metric, as it's the most clinically relevant. Furthermore, GlucoMetrics plots your facility’s hypoglycemia performance against hyperglycemia to ensure you have a full picture of these balancing metrics, and even includes a Glucommander™ customer average so that you can not only track your progress over time internally, but externally against other users.
2. Process metrics like blood glucose check timeliness
Process metrics are essential metrics to track and understand progress in the relevant outcomes. For instance, excellent rates of BG timeliness with IV insulin are associated with improved glycemic outcomes, making it an important process metric for hospitals and health systems to optimize. For example, if you are researching a facility or unit with higher than average rates of hypoglycemia you may want to first check whether or not they have a below-average timeliness rate. While there are many contributors to hypoglycemia BG timeliness does play an important role. GlucoMetrics includes a dashboard that makes tracking this metric easy to do by quickly identifying top and bottom performers in dynamic graphs.
3. Utilization of IV and SubQ insulin, with Glucommander
Any inpatient glycemic management program that leverages an insulin dosing decision support system like Glucommander will find it absolutely imperative to understand the ordering practices of physicians and advanced practice providers. Utilization is a surrogate for ordering practices. This metric can give you a clear understanding of how the technology is taking root, where it is (and is not) being used, and can be tracked over time. GlucoMetrics makes all of this possible, and goes even further by benchmarking your progress against a stated best practice goal.
Once you have access to this data and your glycemic team understands its capabilities, we make it easy to share the data with others. We believe once you access meaningful, timely data, your glycemic team will be equipped with a tool that can enhance efforts to drive change.