Development of Computer-Based Training to Enhance Resident Physician Management of Inpatient Diabetes

Cook, Curtiss B.; Wilson, Rebecca; Hovan, Michael J.; Hull, Bryan P.; Gray, Richard; Apsey, Heidi A.

doi:10.1177/193229680900300618

Cited by 32 publications

(37 citation statements)

References 31 publications

(47 reference statements)

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“…Our study expands data from other similar studies that focused on resident physicians to improve the management of diabetes in hospitalized patients. [20][21][22] In addition, our observations stem from the largest and most comprehensive study to train house staff and evaluated the impact of training on glycemic outcomes in comparison with previous years. Previous studies used a combination of classroom and computer-based teaching and did not include a control group for comparison.…”

Section: Discussionmentioning

confidence: 99%

Improving the Management of Diabetes in Hospitalized Patients: The Results of a Computer-Based House Staff Training Program

Vaidya

Hurwitz

Yialamas

et al. 2012

Diabetes Technology & Therapeutics

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Background: Poorly controlled diabetes in hospitalized patients is associated with poor clinical outcomes. We hypothesized that computer-based diabetes training could improve house staff knowledge and comfort for the management of diabetes in a large tertiary-care hospital. Results: A significant increase in comfort levels and knowledge in the management of inpatient diabetes was seen among house staff at all levels of training (P < 0.02), but the increase was smaller for senior house staff compared with junior house staff. Nonsignificant trends suggesting increased use of basal-bolus insulin (P = 0.06) and decreased use of sliding-scale insulin (P = 0.10) were seen following the educational intervention in 2009, whereas no such change was seen in 2008 (P > 0.90). Overall, house staff evaluated the training program as ''very relevant'' and the technology interface as ''good.'' Conclusions: A computer-based diabetes training program can improve the comfort and knowledge of house staff and potentially improve their insulin administration practices at large academic centers.

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Section: Discussionmentioning

confidence: 99%

Improving the Management of Diabetes in Hospitalized Patients: The Results of a Computer-Based House Staff Training Program

Vaidya

Hurwitz

Yialamas

et al. 2012

Diabetes Technology & Therapeutics

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“…For instance, a multidisciplinary subcommittee has been promoting guidelines for inpatient diabetes care and providing related educational activities to all hospital staff since 2006, including access to an online simulation course on inpatient diabetes management for use by internal medicine and surgical residents. 23 Studies by others have shown that a combination of structured insulin orders combined with staff education to partially alleviates clinical inertia in the hospital. [24][25][26][27][28][29] Our facility implemented computerized order entry in 2007 that includes provisions to order basal, prandial, and correction insulin treatment that are accessible to all practitioners.…”

Section: Discussionmentioning

confidence: 99%

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Coan

Schlinkert

Beck

et al. 2013

J Diabetes Sci Technol

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Objective:Our objective was to assess the application of insulin regimens in surgical postoperative patients with diabetes. Methods:A chart review was conducted of patients with diabetes who were hospitalized postoperatively between January 1 and April 30, 2011. Analysis was restricted to patients hospitalized for ≥3 days and excluded cases with an endocrinology consult. Insulin regimens were categorized as "basal plus short acting," "short acting only," or "none," and the pattern of use was evaluated by hyperglycemia severity according to tertiles of both mean glucose and the number of glucose measurements >180 mg/dl. Results:Among cases selected for analysis (n = 119), examination of changes in insulin use based on tertiles of mean glucose showed that use of basal plus short-acting insulin increased from 10% in the lowest tertile (mean glucose, 120 mg/dl) to 18% in the highest tertile (mean glucose, 198 mg/dl; p < .01); however, 70% of patients in the highest tertile continued to receive short-acting insulin only, with 12% receiving no insulin. Intensification of insulin to a basal plus short-acting regimen was also seen when changes were evaluated by the number of measurements >180 mg/dl (p < .01), but 70% and 12% of patients in the highest tertile still remained only on short-acting insulin or received no insulin, respectively. Conclusions:Use of basal plus short-acting insulin therapy increased with worsening hyperglycemia, but many cases did not have therapy intensified to the recommended insulin regimen-evidence of clinical inertia. Strategies should be devised to overcome inpatient clinical inertia in the treatment of postoperative patients with diabetes.

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“…Several studies with internal medicine residents showed an improvement in their knowledge of inpatient diabetes management, but the effect on patient care was unknown. 7 There was, however, no literature specifically related to diabetes care in children's hospitals.…”

Section: Curriculum Development Processmentioning

confidence: 99%

A Pediatric Resident Diabetes Curriculum Targeting Different Learning Styles

Goldman¹,

Shah²,

Greenberg³

et al. 2012

Diabetes Spectrum

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Development of Computer-Based Training to Enhance Resident Physician Management of Inpatient Diabetes

Cited by 32 publications

References 31 publications

Improving the Management of Diabetes in Hospitalized Patients: The Results of a Computer-Based House Staff Training Program

Improving the Management of Diabetes in Hospitalized Patients: The Results of a Computer-Based House Staff Training Program

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

A Pediatric Resident Diabetes Curriculum Targeting Different Learning Styles

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