Knowledge Translation to Optimize Adult Inpatient Glycemic Management With Basal Bolus Insulin Therapy and Improve...

Area of Science:

• Endocrinology
• Health Services Research
• Medical Education

Background:

• Adoption of best practices in inpatient diabetes management, specifically Basal Bolus Insulin Therapy (BBIT), is often hindered by various barriers.
• Knowledge Translation (KT) strategies are crucial for bridging the gap between evidence-based guidelines and clinical practice.

Purpose of the Study:

• To develop and evaluate a multifaceted Knowledge Translation toolkit designed to overcome barriers to BBIT adoption in adult inpatients.
• To improve the quality of diabetes care and optimize resource utilization within acute care settings.

Main Methods:

• A two-phase study was conducted across four acute care facilities, involving hospitalist providers.
• Phase 1 utilized qualitative methods to identify barriers and facilitators, informing the co-development of the BBIT KT toolkit based on behavior change theory.
• Phase 2 involved the implementation and evaluation of the toolkit, measuring BBIT ordering frequency and clinical outcomes like hyperglycemia, hypoglycemia, and length of stay.

Main Results:

• The BBIT KT toolkit implementation led to a significant 13% absolute increase in BBIT ordering.
• A significant reduction in hyperglycemic patient-days was observed, with no concurrent increase in hypoglycemia.
• The study also documented a significant 14% absolute reduction in acute length of stay.

Conclusions:

• An evidence-informed, multifaceted BBIT KT toolkit effectively addressed a persistent gap in inpatient diabetes care.
• Sustained practice changes resulted in improved patient clinical outcomes and enhanced system resource utilization.
• This systemic implementation approach provides a model for scaling and spreading glycemic optimization initiatives.