TY - JOUR
T1 - Documentation of hypoglycemia assessment among adults with diabetes during clinical encounters in primary care and endocrinology practices
AU - on behalf of the Hypoglycemia as a Quality Measure in Diabetes Study Group
AU - Rodriguez-Gutierrez, Rene
AU - Salcido-Montenegro, Alejandro
AU - Singh-Ospina, Naykky M.
AU - Maraka, Spyridoula
AU - Iñiguez-Ariza, Nicole
AU - Spencer-Bonilla, Gabriela
AU - Tamhane, Shrikant U.
AU - Lipska, Kasia J.
AU - Montori, Victor M.
AU - McCoy, Rozalina G.
N1 - Funding Information:
The authors declare that they have no conflict of interest. R.G.M. is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number K23DK114497. S.M. receives support by the Arkansas Biosciences Institute, the major research component of the Arkansas Tobacco Settlement Proceeds Act of 2000. K.J.L. receives support from the National Institute on Aging and the American Federation of Aging Research through the Paul Beeson Career Development Award (K23AG048359) and from CMS to develop and maintain publicly reported quality measures. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
We thank Darrell Schroeder from the Mayo Clinic Department of Medicine Clinical Research Office and Division of Biostatistics, who was instrumental in identifying patients meeting inclusion criteria for the study and randomly selecting participants for each cohort. R.R.-G., V.M.M. and R.G.M. analyzed the data, designed the research and wrote the manuscript. R.R.-G., A.S.-M., N.M.S.-O., S.M., N.I.-A., G.S.-B., S.U.T., K.J.L., performed the research and analyzed the data and reviewed the manuscript. R.R.-G. and R.G.M. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Purpose: To examine the proportion of diabetes-focused clinical encounters in primary care and endocrinology practices where the evaluation for hypoglycemia is documented; and when it is, identify clinicians’ stated actions in response to patient-reported events. Methods: A total of 470 diabetes-focused encounters among 283 patients nonpregnant adults (≥18 years) with type 1 or type 2 diabetes mellitus in this retrospective cohort study. Participants were randomly identified in blocks of treatment strategy and care location (95 and 52 primary care encounters among hypoglycemia-prone medications (i.e. insulin, sulfonylurea) and others patients, respectively; 94 and 42 endocrinology encounters among hypo-treated and others, respectively). Documentation of hypoglycemia and subsequent management plan in the electronic health record were evaluated. Results: Overall, 132 (46.6%) patients had documentation of hypoglycemia assessment, significantly more prevalent among hypo-treated patients seen in endocrinology than in primary care (72.3% vs. 47.4%; P = 0.001). Hypoglycemia was identified by patient in 38.2% of encounters. Odds of hypoglycemia assessment documentation was highest among the hypo-treated (OR 13.6; 95% CI 5.5−33.74, vs. others) and patients seen in endocrine clinic (OR 4.48; 95% CI 2.3−8.6, vs. primary care). After documentation of hypoglycemia, treatment was modified in 30% primary care and 46% endocrine clinic encounters; P = 0.31. Few patients were referred to diabetes self-management education and support (DSMES). Conclusions: Continued efforts to improve hypoglycemia evaluation, documentation, and management are needed, particularly in primary care. This includes not only screening at-risk patients for hypoglycemia, but also modifying their treatment regimens and/or leveraging DSMES.
AB - Purpose: To examine the proportion of diabetes-focused clinical encounters in primary care and endocrinology practices where the evaluation for hypoglycemia is documented; and when it is, identify clinicians’ stated actions in response to patient-reported events. Methods: A total of 470 diabetes-focused encounters among 283 patients nonpregnant adults (≥18 years) with type 1 or type 2 diabetes mellitus in this retrospective cohort study. Participants were randomly identified in blocks of treatment strategy and care location (95 and 52 primary care encounters among hypoglycemia-prone medications (i.e. insulin, sulfonylurea) and others patients, respectively; 94 and 42 endocrinology encounters among hypo-treated and others, respectively). Documentation of hypoglycemia and subsequent management plan in the electronic health record were evaluated. Results: Overall, 132 (46.6%) patients had documentation of hypoglycemia assessment, significantly more prevalent among hypo-treated patients seen in endocrinology than in primary care (72.3% vs. 47.4%; P = 0.001). Hypoglycemia was identified by patient in 38.2% of encounters. Odds of hypoglycemia assessment documentation was highest among the hypo-treated (OR 13.6; 95% CI 5.5−33.74, vs. others) and patients seen in endocrine clinic (OR 4.48; 95% CI 2.3−8.6, vs. primary care). After documentation of hypoglycemia, treatment was modified in 30% primary care and 46% endocrine clinic encounters; P = 0.31. Few patients were referred to diabetes self-management education and support (DSMES). Conclusions: Continued efforts to improve hypoglycemia evaluation, documentation, and management are needed, particularly in primary care. This includes not only screening at-risk patients for hypoglycemia, but also modifying their treatment regimens and/or leveraging DSMES.
KW - Endocrinology
KW - Healthcare quality
KW - Hypoglycemia
KW - Primary care
KW - Type 1 diabetes
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85076107109&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076107109&partnerID=8YFLogxK
U2 - 10.1007/s12020-019-02147-w
DO - 10.1007/s12020-019-02147-w
M3 - Article
C2 - 31802353
AN - SCOPUS:85076107109
VL - 67
SP - 552
EP - 560
JO - Endocrine
JF - Endocrine
SN - 1355-008X
IS - 3
ER -