Insulin, Healthcare Costs, Diabetes, Quality Improvement

My take on the Glytec-sponsored AHA webinar, Improving the quality and cost of diabetes care. Dr. Jordan Messler.

Jordan Messler, MD, a hospitalist with Morton Plant Hospitalist group (serving BayCare Health) and an Executive Director of Quality Initiatives with Glytec, offers insights on a recent webinar describing how Florida Hospital System (now AdventHealth Orlando) discovered and reduced hypoglycemia risks.

The American Hospital Association recently hosted a webinar sponsored by Glytec that featured two experts in diabetes care and glycemic management: Drs. Richard Pratley and Steven Edelman. The webinar was entitled, Improving the quality and cost of diabetes care: How Florida Hospital System discovered and reduced hypoglycemia risks. In case you missed it, here are some thoughts and reflections, as the content was so important for our industry.

Drs. Pratley and Edelman relayed that one-third of patients in the hospital have diabetes or hyperglycemia. That’s a staggering amount, but, as a hospitalist, it certainly rings true. As we know, management of diabetes in the hospital requires insulin, but insulin is a high-risk medication that contributes to hypoglycemia and causes half of medication-related errors in the hospital. Hypoglycemia leads to increased lengths of stay and readmissions and adds to hospital costs. What amazes me is how front-line hospitalists and hospitals are unaware of the depth of the problem, since we often lack metrics to measure glucose control. Without that knowledge, we are unable to prioritize efforts to improve glucose control on an institutional level. In addition, I frequently see colleagues not managing hyperglycemia effectively, often using outdated treatments, such as reactive care with sliding scale insulin only.

This webinar illustrated the root causes of hypoglycemia and effectively portrayed solutions to combat it. One of the biggest barriers to change is simply the ability to measure and act on data. If hospitals don’t have effective glucometrics or aren’t aware of their hypoglycemia rate, change is unlikely to occur. When managing hyperglycemia in the hospital, providers often use ineffective treatments, such as oral agents, sliding scale insulin only or low doses of insulin. This is a key reason why CMS is developing a hypoglycemia measure, with the goal of improving these outcomes. Few institutions are prepared to meet such a measure in their current state.

Dr. Pratley discussed his health system’s journey to reduce hypoglycemia. Florida Hospital System (now known as AdventHealth Orlando) examined internal data, which revealed that patients with hypoglycemia had significantly higher readmissions, lengths of stay, mortality and costs. They estimated that over a 12-month period, severe hypoglycemia contributed to $7.7 million in excess hospital costs!

Dr. Pratley laid out steps that any organization can take to achieve successful reductions in hypoglycemia while also reducing hyperglycemia and improving glucose control. He described six steps Florida Hospital System exercised to harbor a successful hypoglycemia improvement project that ultimately reduced severe hypoglycemia by 40-95% over paper-based protocols. Here they are:

  1. Make hypoglycemia an institutional priority: sell the case to administrators and leaders. Florida Hospital System leaders are incentivized with hypoglycemia measures on internal dashboards.
  2. Create a multidisciplinary glycemic steering committee.
  3. Develop analytics to drive change, including real-time data, and deliver them in a format the front line can readily utilize.
  4. Standardize care by creating clear protocols and policies, developing provider and nursing education on current standards, and limiting formulary choices, e.g., removing oral diabetes medications such as sulfonylureas.
  5. Implement an integrated technology solution for enterprise glycemic management. In order to enable the standard of care, Florida Hospital System implemented Glytec’s eGlycemic Management System® (eGMS®) for both IV and SQ insulin management. eGMS® also helped Florida Hospital System with real-time surveillance of patients, corrective action and avoiding clinical inertia.
  6. Do all the above using a patient-centered approach, with the goal that each patient receive the right dose of insulin at the time, and for meal times, based on the right food.

Dr. Pratley acknowledged that in partnering with Glytec, their organization’s efforts were accelerated, clinical efficiencies gained and costs reduced. Historically, it has always been a heavy lift to make these improvements at a hospital or health system given the overabundance of priorities and limited resources.

I joined Glytec in part because it offered me the opportunity to support clinical teams with this transformation by assessing current practices and helping migrate policies, workflows and reporting mechanisms to align with best practice. It’s no easy task, but the need to make strides here is clear and will have a profound effect not just on clinical quality improvement and cost reduction, but patient satisfaction as well.

Jordan Messler, MD is a hospitalist with Morton Plant Hospitalist group in Clearwater, Florida (serving BayCare Health) and an Executive Director of Quality Initiatives with Glytec. He previously chaired the Society of Hospital Medicine’s Quality and Patient Safety Committee and has been active in several of their mentoring programs, including Project BOOST and Glycemic Control.

View the recorded webinar and download the slide deck here.

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