Computerized Physician Order Entry- Based Hyperglycemia Inpatient Protocol and Glycemic Outcomes: The CPOE-HIP Study

Abstract

To evaluate the impact of implementing a computerized physician order entry (CPOE)-based hyperglycemia inpatient protocol (HIP) on glycemic outcomes. This retrospective, cross-sectional study compared blood glucose values, hemoglobin A(1c) values, diabetes medication profles, and demographic data of diabetic patients admitted to medicine services between March 15, 2006, and April 11, 2006 (before CPOE-HIP protocol was adopted), with data of diabetic patients admitted between October 3, 2007, and October 30, 2007 (1 year after CPOE-HIP protocol was implemented). A total of 241 diabetic patients comprised the pre-CPOE-HIP group and 197 patients comprised the post-CPOE-HIP group. After the protocol was adopted, there was a decrease of 10.8 mg/dL in the mean glucose concentration per patient-day (175.5 +/- 81.2 mg/dL vs 164.7 +/- 82 mg/dL, P<.001). Additional glycemic control improvements included a 5% increase in patient-days with serum glucose concentrations between 70 and 150 mg/dL (41.1% vs 46.1%, P = .008) and a 3.1% decrease in patient-days with glucose concentrations above 299 mg/dL (16.9% vs 13.8%, P = .023). The percentage of patient-days with glucose concentrations less than or equal to 50 mg/dL was not significantly different (0.95% vs 1.27%,P = .15). Compliance with the American Diabetes Association recommendation for hemoglobin A1c inpatient testing frequency increased from 37.3% to 64.5% (P<.001). The length of stay did not differ between the groups. Implementation of a hospital-wide, CPOE-based, hyperglycemia management protocol had a favorable impact on glucose targets, decreasing excessively high glucose levels without increasing clinically meaningful hypoglycemic events. Compliance with hemoglobin A(1c) testing recommendations also improved.