Electronic Measurement of a Clinical Quality Measure for Inpatient Hypoglycemic Events: A Multicenter Validation Study

Details

• Alternative Title:
  Med Care
• Personal Author:
  Santos, Carlos A. Q. ; Conover, Craig ; Shehab, Nadine ; Geller, Andrew I. ; Guerra, Yannis S. ; Kramer, Holly ; Kosacz, Nicole M. ; Zhang, Huiyuan ; Budnitz, Daniel S. ; Trick, William E.
• Description:
  Background:
  
  Hypoglycemia related to anti-diabetic drugs (ADDs) is an important iatrogenic harm in hospitalized patients. Electronic identification of ADD-related hypoglycemia may be an efficient, reliable method to inform quality improvement.
  
  Objectives:
  
  Develop electronic queries of electronic health records (EHRs) for facility-wide and unit-specific inpatient hypoglycemia event rates and validate query findings with manual chart review.
  
  Methods:
  
  Electronic queries were created to associate blood glucose (BG) values with ADD administration and inpatient location in three tertiary-care hospitals with Patient Centered Outcomes Research Network (PCORnet) databases. Queries were based on National Quality Forum (NQF) criteria with hypoglycemia thresholds <40 mg/dL and <54 mg/dL, and validated using a stratified random sample of 321 BG events. Sensitivity and specificity were calculated with manual chart review as the reference standard.
  
  Results:
  
  The sensitivity and specificity of queries for hypoglycemia events were 97.3% (95% CI, 90.5%-99.7%) and 100.0% (95% CI, 92.6%-100.0%) respectively for BG <40 mg/dL, and 97.7% (95% CI, 93.3%-99.5%) and 100.0% (95% CI, 95.3%-100.0%) respectively for <54 mg/dL. The sensitivity and specificity of the query for identifying ADD days were 91.8% (95% CI, 89.2%-94.0%) and 99.0% (95% CI, 97.5%-99.7%). Of 48 events missed by the queries, 37 (77.1%) were due to incomplete identification of insulin administered by infusion. Facility-wide hypoglycemia rates were 0.4%-0.8% (BG <40 mg/dL) and 1.9%-3.0% (BG <54 mg/dL); rates varied by patient care unit.
  
  Conclusions:
  
  Electronic queries can accurately identify inpatient hypoglycemia. Implementation in non-PCORnet-participating facilities should be assessed, with particular attention to patient location and insulin infusions.
  
  
• Subjects:
  Adult Aged Article Electronic Health Records Humans Hypoglycemia Hypoglycemic Agents Inpatients Insulin Male Middle Aged Quality Indicators, Health Care Tertiary Care Centers

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• Source:
  Med Care. 58(10):927-933
• Pubmed ID:
  32833937
• Pubmed Central ID:
  PMC7492368
• Document Type:
  Journal Article
• Funding:
  HHSD200201796208C/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  58
• Issue:
  10
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:82deb7fd57fd0db1f504933a185d0a2484c8ec4c43187a3c2e970592761c280d
• Download URL:
  https://stacks.cdc.gov/view/cdc/93852/cdc_93852_DS1.pdf
• File Type:
  [PDF - 561.43 KB ]