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Association of inpatient and outpatient glucose management with inpatient mortality among patients with and without diabetes at a major academic medical center.

ABSTRACT: Hospitalized patients with diabetes have experienced a disproportionate reduction in mortality over the past decade.To examine whether this differential decrease affected all patients with diabetes, and to identify explanatory factors.Serial, cross-sectional observational study.Academic medical center.All adult, nonobstetric patients with an inpatient discharge between January 1, 2000 and December 31, 2010.We assessed in-hospital mortality; inpatient glycemic control (percentage of hospital days with glucose below 70, above 299, and between 70 and 179 mg/dL, and standard deviation of glucose measurements), and outpatient glycemic control (hemoglobin A1c).We analyzed 322,938 admissions, including 76,758 (23.8%) with diabetes. Among 54,645 intensive care unit (ICU) admissions, there was a 7.8% relative reduction in the odds of mortality in each successive year for patients with diabetes, adjusted for age, race, payer, length of stay, discharge diagnosis, comorbidities, and service (odds ratio [OR]: 0.923, 95% confidence interval [CI]: 0.906-0.940). This was significantly greater than the 2.6% yearly reduction for those without diabetes (OR: 0.974, 95% CI: 0.963-0.985; P?

SUBMITTER: Butala NM

PROVIDER: S-EPMC4390436 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Association of inpatient and outpatient glucose management with inpatient mortality among patients with and without diabetes at a major academic medical center.

Butala Neel M NM Johnson Benjamin K BK Dziura James D JD Reynolds Jesse S JS Bozzo Janis E JE Balcezak Thomas J TJ Inzucchi Silvio E SE Horwitz Leora I LI

Journal of hospital medicine 20150128 4

<h4>Background</h4>Hospitalized patients with diabetes have experienced a disproportionate reduction in mortality over the past decade.<h4>Objective</h4>To examine whether this differential decrease affected all patients with diabetes, and to identify explanatory factors.<h4>Design</h4>Serial, cross-sectional observational study.<h4>Setting</h4>Academic medical center.<h4>Patients</h4>All adult, nonobstetric patients with an inpatient discharge between January 1, 2000 and December 31, 2010.<h4>M ...[more]

PMID: 25627860

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Project description:ImportanceThere is widespread concern that clinical notes have grown longer and less informative over the past decade. Addressing these concerns requires a better understanding of the magnitude, scope, and potential causes of increased note length and redundancy.ObjectiveTo measure changes between 2009 and 2018 in the length and redundancy of outpatient progress notes across multiple medical specialties and investigate how these measures associate with author experience and method of note entry.Design, setting, and participantsThis cross-sectional study was conducted at Oregon Health & Science University, a large academic medical center. Participants included clinicians and staff who wrote outpatient progress notes between 2009 and 2018 for a random sample of 200 000 patients. Statistical analysis was performed from March to August 2020.ExposuresUse of a comprehensive electronic health record to document patient care.Main outcomes and measuresNote length, note redundancy (ie, the proportion of text identical to the patient's last note), and percentage of templated, copied, or directly typed note text.ResultsA total of 2 704 800 notes written by 6228 primary authors across 46 specialties were included in this study. Median note length increased 60.1% (99% CI, 46.7%-75.2%) from a median of 401 words (interquartile range [IQR], 225-660 words) in 2009 to 642 words (IQR, 399-1007 words) in 2018. Median note redundancy increased 10.9 percentage points (99% CI, 7.5-14.3 percentage points) from 47.9% in 2009 to 58.8% in 2018. Notes written in 2018 had a mean value of just 29.4% (99% CI, 28.2%-30.7%) directly typed text with the remaining 70.6% of text being templated or copied. Mixed-effect linear models found that notes with higher proportions of templated or copied text were significantly longer and more redundant (eg, in the 2-year model, each 1% increase in the proportion of copied or templated note text was associated with 1.5% [95% CI, 1.5%-1.5%] and 1.6% [95% CI, 1.6%-1.6%] increases in note length, respectively). Residents and fellows also wrote significantly (26.3% [95% CI, 25.8%-26.7%]) longer notes than more senior authors, as did more recent hires (1.8% for each year later [95% CI, 1.3%-2.4%]).Conclusions and relevanceIn this study, outpatient progress notes grew longer and more redundant over time, potentially limiting their use in patient care. Interventions aimed at reducing outpatient progress note length and redundancy may need to simultaneously address multiple factors such as note template design and training for both new and established clinicians.

Project description:BackgroundWith health care practice consolidation, the increasing geographic scope of health care systems, and the advancement of mobile telecommunications, there is increasing interest in telemedicine-based health care consultations. Anesthesiology has had experience with telemedicine consultation for preoperative evaluation since 2004, but the majority of studies have been conducted in rural settings. There is a paucity of literature of use in metropolitan areas. In this article, we describe the implementation of a telemedicine-based anesthesia preoperative evaluation and report the program's patient satisfaction, clinical case cancellation rate outcomes, and cost savings in a large metropolitan area (Los Angeles, CA).MethodsThis is a descriptive study of a telemedicine-based preoperative anesthesia evaluation process in an academic medical center within a large metropolitan area. In a 2-year period, we evaluated 419 patients scheduled for surgery by telemedicine and 1785 patients who were evaluated in-person.ResultsDay-of-surgery case cancellations were 2.95% and 3.23% in the telemedicine and the in-person cohort, respectively. Telemedicine patients avoided a median round trip driving distance of 63 miles (Q1 24; Q3 119) and a median time saved of 137 (Q1 95; Q3 195) and 130 (Q1 91; Q3 237) minutes during morning and afternoon traffic conditions, respectively. Patients experienced time-based savings, particularly from traveling across a metropolitan area, which amounted to $67 of direct and opportunity cost savings. From patient satisfaction surveys, 98% (129 patients out of 131 completed surveys) of patients who were consulted via telemedicine were satisfied with their experience.ConclusionsThis study demonstrates the implementation of a telemedicine-based preoperative anesthesia evaluation from an academic medical center in a metropolitan area with high patient satisfaction, cost savings, and without increase in day-of-procedure case cancellations.

Dataset Information

Association of inpatient and outpatient glucose management with inpatient mortality among patients with and without diabetes at a major academic medical center.

Publications

Association of inpatient and outpatient glucose management with inpatient mortality among patients with and without diabetes at a major academic medical center.

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