Diabetes Mellitus Clinical Trial
Official title:
Perioperative Diabetes Care: Developing and Testing an Implementation Strategy in Terms of Effectiveness, Experiences and Costs
Optimising glycaemic control during hospital stay reduces the rate of infections, length of stay and mortality, in particular in surgical patients. In this study, we test a strategy to implement optimal perioperative diabetes care in a controlled before and after design in 6 Dutch hospitals.
OBJECTIVE/RESEARCH QUESTION Optimising glycaemic control during hospital stay reduces rate of
infections, length of stay and mortality,in particular in surgical patients. In guidelines
and literature recommendations on optimal perioperative diabetes care are described.
Nevertheless, in daily practice, perioperative glycaemic control is very often not achieved.
This study aims at developing an implementation strategy that is tested on feasibility to
improve perioperative diabetes care in terms of effectiveness, experiences and costs.
DESIGN/OUTCOME MEASURES/IMPLEMENTATION STRATEGY A step-wise implementation model is applied:
1) recommendations on optimal perioperative diabetes care (e.g. the administration of
intravenous insulin, encouragement of diabetes self-management) are systematically translated
into quality indicators; 2a) using these quality indicators, current care is measured by
performing a medical record search among 400 patients in 6 hospitals; 2b) barriers and
facilitators for optimal care are measured by performing interviews with professionals and,
e.g. regarding self-management, with patients; 3) based on this information an implementation
strategy is developed;4) implementation activities are enacted and 5) evaluated in a
controlled before-after design in 6 hospitals providing before and after intervention 400
patients.
DATA ANALYSIS To obtain an indication of the effectiveness of the strategy, baseline and post
intervention outcomes of intervention hospitals are compared with outcomes in control
hospitals, using the quality indicators. Experiences of participants in the intervention
hospitals will be measured to, if necessary, adapt the strategy to make it more effective and
acceptable.
ECONOMIC EVALUATION A cost analysis of the implementation strategy will take place.
Implementation costs will be related to the difference in percentage of patients treated as
described in the quality indicators before and after implementation. Information on the costs
and effects at the patient level will also be compared before and after the implementation of
the recommendations on optimal care.
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