Pragmatic review of interventions to prevent inpatient hypoglycaemia

Abstract

Aims: This pragmatic review aimed to map and summarize the literature on model of care interventions to prevent inpatient hypoglycaemia. Model of care interventions were broadly defined as interventions that either directly target the workforce or where implementation had a strong workforce effect. The review intended to provide information for decision-makers in local health care settings regarding potential interventions to prevent inpatient hypoglycaemia in their local context. Methods: PubMed, Embase, CINAHL Plus and Scopus were systematically searched from 2009 to 2019 using key search terms for hypoglycaemia and hospital and evaluation. Included articles had to report an inpatient hypoglycaemiarelated outcome. Interventions were categorized by intervention type and setting. Dysglycaemia outcomes were extracted (severe-hypoglycaemia, hypoglycaemia, hyperglycaemia and severe-hyperglycaemia).Results: Forty-nine articles were included in the review. Interventions were categorized as: services (n = 8), role expansion (n = 6), education (n = 9), audit and feedback (n = 1), alerts and reminders (n = 3), protocol implementation methods (n = 1), order sets (n = 6), insulin charts (n = 1) and electronic glycaemic management systems (n = 14). Twenty-one articles reported on ICU-specific interventions, and 28 on interventions in non-ICU-specific settings. Study designs were predominantly non-randomized (n = 40). Conclusions: The review found positive evidence for a diverse range of evaluated interventions to prevent inpatient hypoglycaemia. Local decision-makers can use this review to identify interventions relevant to their local context. We suggest they evaluate those interventions using a decision analytic framework that combines the published evidence on effectiveness with local prevalence data to estimate the expected cost-effectiveness of the intervention options when implemented in their local context.

A framework for local-level economic evaluation to inform implementation decisions: health service interventions to prevent hospital-acquired hypoglycemia

“…Pragmatic literature review of intervention options A pragmatic literature review was undertaken that identified fortynine publications for forty-seven studies. Full details of the review are available as a published paper (6).…”

“…It is noted that “the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results” have also been identified as barriers to the use of economic evaluation (23). However, transferable tools and materials were developed, including the clinical audit tool, the pragmatic literature review (6), the elicitation framework (15), and code for data analysis and economic modeling. Options for the dissemination of these resources include a consultancy model or training courses with resources developed to upskill local personnel to apply the evaluation tools and materials locally.…”

Using Expert Elicitation to Adjust Published Intervention Effects to Reflect the Local Context

“…Health service delivery models are used to organize the effective delivery of health care. Based on a pragmatic literature review of potential delivery model intervention options 6 and a preliminary assessment of expected costs and benefits, the working group selected 2 interventions to be included in the final local-level economic analysis:…”

Equitable Machine Learning for Hypoglycaemia Risk Management

“…While risk factors for inpatient hypoglycaemia are well known, some of them evolve dynamically during the patient stay, which limits the effectiveness of a single risk assessment on admission. In addition, evidence supporting interventions to reduce inpatient hypoglycaemia is limited, with education interventions, audit and feedback shown to be ineffective, for the most part, at reducing inpatient hypoglycaemia [4]. Conversely, published evidence supports the use of predictive-informatics risk-alert systems.…”