Implementation of an Electronic Dashboard with A Remote Management System to Improve Glycemic Management Among Hospitalized Adults |
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| Institution: | 1. From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan;2. Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan;3. Department of Public Health, China Medical University, Taichung, Taiwan;4. Department of Computer & Communications Center, Taichung Veterans General Hospital, Taiwan;5. Division of Clinical Information, Center of Quality Management, Taichung Veterans General Hospital, Taiwan;6. Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan;7. School of Medicine, Chung Shan Medical University, Taichung City, Taiwan;8. College of Science, Tunghai University, Taichung City, Taiwan;9. Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan;10. School of Medicine, National Defense Medical Center, Taipei, Taiwan.;1. From the Internal Medicine Department, Cairo University, Egypt;2. Vascular Laboratory, Cairo University, Egypt;3. Internal Medicine Department, Alexandria University Hospital, Egypt. |
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| Abstract: | Objective: Better glycemic control for hospitalized diabetic patients significantly reduces health expenditures and improves disease outcomes. We developed a dynamic dashboard with a remote management system and evaluated its impact on inpatient glycemic control.Methods: This was an observational institution-wide study; study participants were enrolled from a 1,500-bed public medical center from 2016 to 2018. We evaluated the impact of a dynamic dashboard system, which analyzed and monitored all glucose data with virtual glycemic management recommendation by a team of endocrinologists, over 3 × 1-year periods: 2016 (pre-implementation), 2017 (development), and 2018 (implementation).Results: A total of 51,641 discharges with 878,159 blood glucose measurements were obtained during the 3-year period. After implementation of the dashboard system, the proportion of patients with poor glycemic control (hyperglycemia or hypoglycemia) was reduced by 31% (from 10.2 to 7.0 per day per 100 patients with glucose monitoring; P<.001); hyperglycemia decreased by 25% (from 6.1 to 4.6 per day per 100 patients with glucose monitoring; P<.001), and hypoglycemia decreased by 45% (from 4.2 to 2.3 per day per 100 patients with glucose monitoring; P<.001). Furthermore, the trend in the proportion of patients within the treat-to-target range showed significant improvement (P<.001) during the development period, with effectiveness maintained throughout the implementation period.Conclusion: We successfully installed a dynamic, electronic medical records-based dashboard monitoring system to improve inpatient glycemic control. The system, supported by a team of endocrinologists via remote recommendations, could efficiently fill an important need for improved glycemic management among hospitalized adults.Abbreviations: CDE = certified diabetes educator; DM = diabetes mellitus; EMR = electronic medical record; POC = point-of-care; TCVGH = Taichung Veterans General Hospital; UCSF = University of California, San Francisco; U.S. = United States; vGMS = virtual glucose management service |
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