How Sweet Is It? The Use of Benchmarking to Optimize Inpatient Glycemic Control.

Abstract

> “You can't improve what you can't measure.” > > —Anonymous Inpatient hyperglycemia is a very common condition, affecting 32–38% of patients in the non–intensive care unit (non-ICU) setting. Observational and randomized, controlled studies suggest that improved glycemic control results in lower rates of hospital complications in general medical and surgical patients.1 Hypoglycemic adverse drug events are also common in the hospital setting, and approximately half of these events are preventable.1,2 Hypoglycemia management is often delayed and ineffective in preventing recurrent hypoglycemia.3–5 The Society of Hospital Medicine (SHM) has joined other organizations in stressing the importance of improving glycemic control while paying proper attention to hypoglycemia prevention and management.1,2,6–9 Although all hospitals address these issues to some extent, many attempt to implement a variety of interventions and resources with minimal capacity to assess the positive (or unintentionally negative) consequences of their investment.1,9 Difficulties in measuring, analyzing, tracking, and benchmarking the quality of inpatient glycemic control were identified as rate-limiting steps in the improvement process as SHM engaged hospitals in collaborative improvement efforts.1,8–13 Subsequently, SHM partnered with a data management company (QuesGen Systems, Burlingame, Calif.) to develop a Web-based data and reporting center for a wide range of measures using glucose values (also called “glucometrics”)14 that would allow hospitals to assess their baseline performance, track their progress over time, and compare performance across similar units within their institution. In addition to these measures and internal benchmarking capacity, SHM also created external benchmarking reports, allowing for comparisons of performance across different institutions in the database. Hospitals enrolled in the SHM Glycemic Control Mentored Implementation programs, or that subscribe to an electronic quality improvement program in glycemic control, upload blood glucose data in …