Effectively Identifying the Inpatient With Hyperglycemia to Increase Patient Care and Lower Costs

Abstract

Recent years have seen an increased focus on merging quality care and financial results. This focus not only extends to the inpatient setting but also is of major importance in assuring effective transitions of care from hospital to home. Inducements to meld the 2 factors include tying payment to quality standards, investing in patient safety, and offering new incentives for providers who deliver high-quality and coordinated care. Once seen as the purview of primary care or specific surgical screening programs, identification of patients with hyperglycemia or undiagnosed diabetes mellitus now presents providers with opportunities to improve care. Part of the new focus will need to address the length of stay for patients with diabetes mellitus. These patients are proven to require longer hospital stays regardless of the admission diagnosis. With reducing length of stay as a major objective, efficiency combined with improved quality is the desired outcome. Even with the mounting evidence supporting the benefits of improving glycemic control in the hospital setting, institutions continue to struggle with inpatient glycemic control. Multiple national groups have provided recommendations for blood glucose assessment and glycated hemoglobin testing. This article identifies the key benefits in identifying patients with hyperglycemia and reviews possible ways to identify, monitor, and treat this potential problem area and thereby increase the level of patient care and cost-effectiveness.

Early treatment revisions by addition or switch for type 2 diabetes: impact on glycemic control, diabetic complications, and healthcare costs

“…HbA1c has been identified as the strongest predictor of hospitalisation in persons with diabetes, in that better glycemic control is associated with fewer hospitalisations and lower inpatient costs when hospitalisations do occur. 7 8 …”

The Reply

“…Even with the mounting evidence supporting the benefits of improving glycemic control in the hospital setting, many institutions continue to struggle with this issue. 1 Anecdotally, we see many health care providers who find the subject challenging. Our manuscript was meant to summarize strategies and guidelines for inpatient glycemic control and provide an educational overview of the topic that would encourage providers to strive for improved care of hyperglycemic inpatients.…”

InsulinAPP application protocol for the inpatient management of type 2 diabetes on a hospitalist-managed ward: a retrospective study

“…Observational studies indicate that in-hospital hyperglycemia affects 32% to 38% of non-critical patients (1,3). Early diagnosis and adequate treatment of hyperglycemia have been shown to reduce morbidity, length of stay (LOS), readmission rate, need for admission to intensive care unit (ICU), hospital costs, and hospital mortality (4)(5)(6)(7). Despite this evidence, inpatient glycemic control remains unsatisfactory, particularly because of treatment complexity and fear of hypoglycemia (1,(8)(9)(10).…”