Determining rate of compliance with the American diabetes association recommendations in hospitalized patients
Diabetes mellitus is a growing epidemic in the United States associated with significant economic costs, reduced quality of life, long-term complications, and high rates of morbidity and mortality. Purpose: This study determined the rate of compliance in hospitalized patients with the ADA treatment recommendations for diabetes management with regards to: blood glucose management, cholesterol management, stroke prevention, ACE-I/ARB utilization, and pneumococcal vaccination (PPV). Methodology: This retrospective, non-interventional, chart review took place at a 760 bed, tertiary care, teaching hospital. A computer-generated list of patients with diabetes ICD-9 codes 250.0 through 250.9 was obtained. All adult patients, ≥ 18 years old, consecutively discharged from a general medical unit, beginning April 1, 2006 were included until data on 100 patients were collected. Exclusion criteria included gestational diabetes, hospital admission < 3days, and death prior to discharge. The following measurements related to the study objectives were collected: blood glucose, cholesterol management, stroke prevention, ACE-I/ARB utilization, and PPV immunization. Results: Of the 100 patients reviewed, 96% had Type II DM; 24% had contraindications to at least one of their prescribed oral DM medications. Only 57% had HgA1c documented; of these, 56% were at goal. Only 42% had LDL cholesterol documented; of these, 76% were at goal. Appropriate stroke prevention was prescribed for 75% of patients; 69% were receiving appropriate ACE-I therapy; and 38% of eligible patients received PPV. Conclusions: A high percentage of hospitalized patients are not in full compliance with the ADA treatment guidelines.
A project presented to the Department of Physician Assistant of Wichita State University in partial fulfillment of the requirements for the degree of Master of Physician Assistant.
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