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Impact of a multifaceted strategy to improve perioperative diabetes care
Author(s) -
Hommel I.,
Wollersheim H.,
Tack C. J.,
Mulder J.,
Gurp P. J.,
Hulscher M. E. J. L.
Publication year - 2017
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13130
Subject(s) - medicine , perioperative , diabetes mellitus , psychological intervention , multidisciplinary approach , emergency medicine , intervention (counseling) , protocol (science) , intensive care medicine , quality management , surgery , nursing , alternative medicine , social science , management system , management , pathology , sociology , economics , endocrinology
Aims To assess the impact of a multifaceted strategy to improve perioperative diabetes care throughout the hospital care pathway. Methods We conducted a controlled before‐and‐after study in six hospitals. The purpose of the strategy was to target four predominant barriers that obstruct optimal care delivery. We provided feedback on baseline indicator performance, developed a multidisciplinary protocol and patient information, and provided professional education. After a 6‐month intervention, we determined the performance changes against three outcome indicators and nine process indicators using data on 811 patients with diabetes who underwent major surgery. The progress of the interventions was monitored closely. Results Two process indicators improved significantly in the intervention hospitals: the proportion of patients for whom glycaemic control had been evaluated preoperatively increased by 9% ( P < 0.002) and the proportion of patients with blood glucose measurements within 1 h after surgery increased by 29% ( P < 0.0001). Four other process indicators and all three outcome indicators improved more in the intervention hospitals than in the control hospitals, but the differences were not statistically significant. These included the proportion of patients with all glucose values at 6–10 mmol/l (+3%) and the proportion of patients with hyperglycaemia (−8%). The implementation of the multidisciplinary protocol was still ongoing after the 6‐month intervention period. Conclusions The multifaceted improvement strategy had a limited impact on the quality of perioperative diabetes care. This study demonstrates the complexity of improving perioperative diabetes care throughout the multiprofessional hospital care pathway.