Skip to main content
Top

30-01-2017 | Type 2 diabetes | Review | Article

Transitioning the Adult with Type 2 Diabetes From the Acute to Chronic Care Setting: Strategies to Support Pragmatic Implementation Success

Journal: Current Diabetes Reports

Authors: Michelle Magee, Joan K. Bardsley, Amisha Wallia, Kelly M. Smith

Publisher: Springer US

Abstract

Scientific evidence is available to guide the how to of medications management when patients with diabetes are hospitalized or present to the Emergency Department. However, few clinical trials in the diabetes field have addressed the execution, coupled with established implementation effectiveness evaluation frameworks to help inform and assess implementation practices to support the transition in care. These deficiencies may be overcome by (1) applying the principles of implementation and delivery systems science; (2) engaging the principles of human factors (HF) throughout the design, development, and evaluation planning activities; and (3) utilizing mixed methods to design the intervention, workflow processes, and evaluate the intervention for sustainability within existing care delivery models. This article provides a discussion of implementation science and human factors science including an overview of commonly used frameworks which can be applied to structure design and implementation of sustainable and generalizable interventions.
Literature
1.
Narayan KM, Boyle JP, Geiss LS, et al. Impact of recent increase in incidence on future diabetes burden: US 2005-2050. Diabetes Care. 2006;29:2114–6.CrossRefPubMed
2.
Huang ES, Basu A, O’Grady M. Projecting the future diabetes populations size and related costs for the U.S. Diabetes Care. 2009;32:2225–9.CrossRefPubMedPubMedCentral
3.
• Magee MF, Khan NH, Desale S, et al. Diabetes to Go: knowledge- and competency-based hospital survival skills diabetes education program improves post-discharge medication adherence. Diabetes Educ. 2014;40:344–50. doi:10.​1177/​0145721714523684​. This article provides the evidence of a successful implementation framework for diabetes education. CrossRefPubMed
4.
•• Rodriguez K, Meneghini L, Seley JJ et al. Patient education in inpatient management of diabetes. American Diabetes Association 2016. The standards of care include the latest evidence for management of diabetes.
5.
Maynard G, Lee J, Phillips G, et al. Improved inpatient use of basal insulin, reduced hypoglycemia, and improved glycemic control: effect of structured subcutaneous insulin orders and an insulin management algorithm. J Hospital Med. 2009;4:3–15.CrossRef
6.
Umpierrez GE, Smiley D, Zisman A, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007;30:2181–6.CrossRefPubMed
7.
Donihi AC, Di NarDiNardo MM, DeVita MA, et al. Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin. Qual Saf Health Care. 2006;15:89–91.CrossRefPubMedPubMedCentral
8.
Umpierrez GE, Reyes D, Smiley D, et al. Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes. Diabetes Care. 2014;37:2934–9. doi:10.​2337/​dc14-0479.CrossRefPubMedPubMedCentral
9.
Babu A, Mehta A, Guerrero P, et al. Safe and simple emergency department discharge therapy for patients with type 2 diabetes mellitus and severe hyperglycemia. Endocr Pract. 2009;15:696–704.CrossRefPubMed
10.
Magee MF, Nassar CM, Mete M, et al. The Synergy to Control Emergency Department Hyperglycemia Program for type 2 diabetes: STEP-Diabetes. Endocr Pract. 2015;21:1227–39.CrossRefPubMed
11.
Munoz C, Villanueva G, Fogg L, et al. Impact of a subcutaneous insulin protocol in the emergency department: RushEmergency Department Hyperglycemia Intervention (REDHI). J Emerg Med. 2011;40:493–8. doi:10.​1016/​j.​jemermed.​2008.​03.​017.CrossRefPubMed
12.
Bernard JB, Munoz C, Harper J, et al. Treatment of inpatient hyperglycemia beginning in the emergency department: a randomized trial using insulins aspart and detemir compared with usual care. J Hosp Med. 2011;6:279–84. doi:10.​1002/​jhm.​866.CrossRefPubMed
13.
Magee MF, Nassar CM, Mete M, White K, Youssef GA, Dubin JS. The synergy to enable glycemic control following emergency department discharge program for adults with type 2 diabetes: step-diabetes. Endocrine Pract : Off J Am College Endocrinol Am Assoc Clin Endocrinol. 2015;21:1227–39.CrossRef
14.
Diabetes Care in the Hospital. American Diabetes Association Standards of Medical Care for Diabetes -2016. Diabetes Care. 2016; 39 (Supplement 1): S99-S104. doi: 10.​2337/​dc16-S016.
15.
Rodrigues A, Magee M, Ramos P, et al. Best practices for interdisciplinary care management by hospital glycemic teams: results of a Society of Hospital Medicine survey among 19 US hospitals. Diabetes Spectrum. 2014;27:197–206.CrossRef
16.
Glasgow RE. What does it mean to be pragmatic? pragmatic methods, measures, and models to facilitate research translation. Health Educ Behav. 2013;40:257–65.CrossRefPubMed
17.
Ellrodt G, Cook DJ, Lee J, et al. Evidence-based disease management. JAMA. 1997;278:1687–92.CrossRefPubMed
18.
Epstein RS, Sherwood LM. From outcomes research to disease management: a guide for the perplexed. Ann Intern Med. 1996;124:832–7.CrossRefPubMed
19.
Glasgow RE, Wagner EH, Kaplan RM. If diabetes is a public health problem, why not treat it as one? a population-based approach to chronic illness. Ann Behav Med. 1999;21(Spring):159–70.CrossRefPubMed
20.
Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002;288:1909–14.CrossRefPubMed
21.
Transitions of Care Measures. NTOCC Measures Working Group, 2008. Accessed 5-24-16 at http://​www.​ntocc.​org/​Portals/​0/​PDF/​Resources/​TransitionsOfCar​e_​Measures.​pdf.
22.
Health Indicators Warehouse. Healthcare Effectiveness Data and Information System. http://​www.​healthindicators​.​gov/​Resources/​DataSources/​HEDIS_​56/​Profile.
23.
Frohlich KL, Potvin L. The inequality paradox: the population approach and vulnerable populations. Am J Publ Hlth. 2008;98:216–20.CrossRef
24.
The TRIAD Study Group. Health systems, patients factors and quality of care for diabetes: a synthesis of findings from the TRIAD study. Diabetes Care. 2010;33:940–7. doi:10.​2337/​dc09-1802.CrossRefPubMedCentral
25.
Russell MA, Phipps MG, Olson CL, et al. Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol. 2006;108:1456–62.CrossRefPubMed
26.
Ferrara A, Hedderson M, Albright CL, et al. A pregnancy and postpartum lifestyle intervention in women with GDM reduces diabetes risk factors: a feasibility randomized control trial. Diabetes Care. 2011;34:1519–25.CrossRefPubMedPubMedCentral
27.
Ehrlich SF, Hedderson MM, Quesenberry Jr CP, et al. Post-partum weight loss and glucose metabolism in women with gestational diabetes: the DEBI Study. Diabet Med. 2014;31:862–7. doi:10.​1111/​dme.​12425.CrossRefPubMedPubMedCentral
28.
Ferrara A, Hedderson MM, Albright CL, et al. A pragmatic cluster randomized clinical trial of diabetes prevention strategies for women with gestational diabetes: design and rationale of the Gestational Diabetes’ Effects on Moms (GEM) study. BMC Pregnancy Childbirth. 2014;14:21.CrossRefPubMedPubMedCentral
29.
Ferrara A, Hedderson MM, Albright CL, et al. Reduced postpartum weight retention with a DPP-derived lifestyle intervention: The Gestational Diabetes’ Effects on Moms (GEM) cluster randomized trial [abstract]Ferrara A, Hedderson MM, Albright CL et al. Diabetes. 2014;63.
30.
Ferrara A, Peng T, Kim C. Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus. a report from the Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care. 2009;32:269–74.CrossRefPubMedPubMedCentral
31.
Committee on an Evidence Framework for Obesity Prevention Decision Making, Institute of Medicine. Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making. National Academies Press, 2010.
32.
Coleman EA, Parry C, Chalmers S, et al. The care transitions intervention: results of a randomized controlled trial. Arch Int Med. 2006;166:1822–8. doi:10.​1001/​archinte.​166.​17.​1822.CrossRef
33.
Voss R, Gardner R, Baier R, et al. The care transitions intervention: translating from efficacy to effectiveness. Arch Int Med. 2011;171:1232–7. doi:10.​1001/​archinternmed.​2011.​278.CrossRef
34.
Clay-Williams R, Nosrati H, Cunningham FC, et al. Do large-scale hospital- and system-wide interventions improve patient outcomes: a systematic review. BMC Health Serv Res. 2014;14:369. doi:10.​1186/​1472-6963-14-369.CrossRefPubMedPubMedCentral
35.
Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344–9. http://​www.​sciencedirect.​com/​science/​article/​B6T84-4S0MXBS-6/​2/​9bb4898e5439f9b3​06852ecb8472cf8e​.CrossRef
36.
Kottke TE, Solberg LI, Nelson AF, et al. Optimizing practice through research: a new perspective to solve an old problem. Ann Fam Med. 2008;6:459–62. doi:10.​1370/​afm.​862.CrossRefPubMedPubMedCentral
37.
Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf. 2008;34:228–43. http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​18468362. Accessed January 25, 2015.CrossRefPubMed
38.
Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ. 2008;337(oct06_1):a1714. doi:10.​1136/​bmj.​a1714.CrossRefPubMed
40.
Pronovost PJ, Goeschel CA, Marsteller JA, et al. Framework for patient safety research and improvement. Circulation. 2009;119:330–7. doi:10.​1161/​CIRCULATIONAHA.​107.​729848.CrossRefPubMed
41.
Stellefson M, Chaney B, Barry AE. Web 2.0 chronic disease self-management for older adults: a systematic review. J Med Internet Res. 2013;15:e35. doi:10.​2196/​jmir.​2439.CrossRefPubMedPubMedCentral
42.
Dzewaltowski DA, Glasgow RE, Klesges LM, et al. RE-AIM: evidence-based standards and a Web resource to improve translation of research into practice. Ann Behav Med. 2004;28:75–80.CrossRefPubMed
43.
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–7.CrossRefPubMedPubMedCentral
44.
Glasgow RE, McKay HG, Piette JD, et al. The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management? Patient Educ Couns. 2001;44:119–27.CrossRefPubMed
45.
Illuri V, Khorzad R, Derby T et al. A failure mode effects and criticality analysis identifies variability in inpatient diabetes education comprehension as a high risk failure in transitions of care. American Diabetes Association 75th Scientific Session; 2015; Boston, MA: Conference Abstract.
46.
Nagpal K, Vats A, Ahmed K, et al. A systematic quantitative assessment of risks associated with poor communication in surgical care. Arch Surg. 2010;145:582–8.CrossRefPubMed
47.
Stamatis DH. Failure mode and effect analysis: FMEA from theory to execution. 2nd ed. Milwaukee, Wisc.: ASQ Quality Press; 2003. xxxi, 455 p. p.
48.
•• Russ AL, Fairbanks RJ, Karsh BT, et al. The science of human factors: separating fact from fiction. BMJ Qual Saf. 2013;22:802–8. doi:10.​1136/​bmjqs-2012-001450. This reference provides the evidence and utilization of human factors design. CrossRefPubMedPubMedCentral
49.
Catchpole K. Spreading human factors expertise in healthcare: untangling the knots in people and systems. BMJ Qual Saf. 2013;22:793–7.CrossRefPubMed
50.
Gosbee J, Gosbee LL. Using human factors engineering to improve patient safety: Joint Commission Resources, Inc.; 2005.
51.
Karsh BT, Holden RJ, Alper SJ, et al. A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional. Qual Saf Health Care. 2006;15 Suppl 1:i59–65.CrossRefPubMedPubMedCentral
52.
Baum F, MacDougall C, Smith D. Participatory action research. J Epidemiol Community Health. 2006;60:854–7. doi:10.​1136/​jech.​2004.​028662.CrossRefPubMedPubMedCentral
53.
Arthur HM, Wright DM, Smith KM. Women and heart disease: the treatment may end but the suffering continues. Can J Nurs Res. 2001;33:17–29.PubMed
54.
Realpe A, Wallace LM. 2010.
55.
Gilson L, Hanson K, Sheikh K, et al. Building the field of health policy and systems research: social science matters. PLoS Med. 2011;8:e1001079. doi:10.​1371/​journal.​pmed.​1001079.CrossRefPubMedPubMedCentral
56.
CDC’s Division of Diabetes Translation. Available at: www.​cdc.​gov/​diabetes/​statistics/​dmany/​fig1.​htm. Accessed: 2/20/2016.
57.
American Diabetes Association. Diabetes Care. 2013.
58.
Healthcare cost and utilization project (HCUP).: Agency for Healthcare Research and Quality (AHRQ). 2014. Available at: http://​hcupnet.​ahrq.​gov/​HCUPnet.​jsp. Accessed: 5-23-2016.
59.
Axon RN, Williams MV. Hospital readmission as an accountability measure. JAMA. 2011;305:504–5. doi:10.​1001/​jama.​2011.​72.CrossRefPubMed
60.
Stone J, Hoffman GJ. Medicare hospital readmissions: Issues, policy options and PPACA. Congressional Research Service. 2010 http://​www.​hospitalmedicine​.​org/​AM/​pdf/​advocacy/​CRS_​Readmissions_​Report.​pdf. Accessed 23 Jan 2015.
61.
Epstein AM. Revisiting readmissions changing the incentives for shared accountability. N Engl J Med. 2009;360:1457–9. doi:10.​1056/​NEJMe0901006.CrossRefPubMed
62.
Project RED (Re-Engineered Discharge). http://​www.​bu.​edu/​fammed/​projectred/​ Accessed 23 Jan 2015.
63.
Hansen LO, Greenwald JL, Budnitz T, et al. Project BOOST: effectiveness of a multihospital effort to reduce rehospitalizations. J Hospital Med. 2013;8:421–7. doi:10.​1002/​jhm.​2054.CrossRef
64.
Moore C, Wisnivesky J, Williams S, et al. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18:646–51.CrossRefPubMedPubMedCentral
65.
Montejano L, Vo L, McMorrow D. Transitions of care for people with type 2 diabetes: utilization of antihyhperglycemic agents per-and post-hospitalization. Diabetes Ther. 2016;7:91–103.CrossRefPubMed
66.
Rubin DJ. Hospital readmission of patients with diabetes. Curr Diab Rep. 2015;15:584.CrossRef
67.
Rubin DJ, Donnell-Jackson K, Jhingan R, et al. Early readmission among patients with diabetes: a qualitative assessment of contributing factors. J Diabetes Complications. 2014;28:869–73. doi:10.​1016/​j.​jdiacomp.​2014.​06.​013.CrossRefPubMed
69.
Coleman, ErA. Commissioned Paper: Transitional Care Performance Measurement. Performance Measurement Report, Institute of Medicine, 2006. Appendix I, 250–276.
70.
Position Statement: Improving the Quality of Transitional Care for Persons with Complex Care Needs. American Geriatrics Society. May 2002. Available at http://​www.​americangeriatri​cs.​org/​products/​positionpapers/​complex_​care.​shtml.
71.
One Patient, Many Places: Managing Health Care Transitions. HMO Care Management Work Group. February 2004. Available at http://​www.​ahip.​org/​content/​default.​aspx?​bc=​38%7C65%7C69.
72.
McElroy LM, Khorzad R, Nannicelli AP, et al. Failure mode and effects analysis: a comparison of two common risk prioritisation methods. BMJ Qual Saf. 2016;25:329–36.CrossRefPubMed
73.
Prabhakaran S, Khorzad R, Brown A, et al. Academic-community hospital comparison of vulnerabilities in door-to-needle process for acute ischemic stroke. Circ Cardiovasc Qual Outcomes. 2015;8(6 Suppl 3):S148–54. doi:10.​1161/​CIRCOUTCOMES.​115.​002085.CrossRefPubMed
74.
Illuri V, Khorzad R, Derby T et al. Risk assessment of the diabetes discharge process reveals industry and systems levels failures. Research Letter Submitted for publication.
75.
Magee MF, Smith KM, et al. NIH R34 ongoing “Diabetes To Go Inpatient” Study (1-R34-DK-109503-01). https://​www.​medstarhealth.​org/​mhri/​2016/​03/​22/​nih-funds-medstar-program-diabetes-to-go-to-educate-from-the-bedside/​#q=​{}. Accessed October 11, 2016.
76.
Lewis VR, Benda N, Nassar C, et al. Successful patient diabetes education in the emergency department. Diabetes Educ. 2015;41:343–50.CrossRefPubMed

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »