Trial reportJournal of the American Medical Informatics Association : JAMIA
Use of a computerized guideline for glucose regulation in the intensive care unit improved both guideline adherence and glucose regulation.
Trial report in Journal of the American Medical Informatics Association : JAMIA. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 13 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
60 citing papers in PubMed, 13 syntheses or guidelines pooled it, 5 citations in OpenAlex.
- Pooled it
- Use and effects of implementation strategies for practice guidelines in nursing: a systematic review.Implementation science : IS · 2021Pooled it
- Tools developed and disseminated by guideline producers to promote the uptake of their guidelines.The Cochrane database of systematic reviews · 2016Pooled it
- Interventions to improve adherence to cardiovascular disease guidelines: a systematic review.BMC family practice · 2015Pooled it
- Systematic review of clinical decision support interventions with potential for inpatient cost reduction.BMC medical informatics and decision making · 2013Pooled it
- Computerized advice on drug dosage to improve prescribing practice.The Cochrane database of systematic reviews · 2013Pooled it
- Computerized clinical decision support systems for therapeutic drug monitoring and dosing: a decision-maker-researcher partnership systematic review.Implementation science : IS · 2011Pooled it
- Computerized clinical decision support systems for acute care management: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes.Implementation science : IS · 2011Pooled it
- The effectiveness of computerized clinical guidelines in the process of care: a systematic review.BMC health services research · 2010Pooled it
- Tight glycemic control and computerized decision-support systems: a systematic review.Intensive care medicine · 2009Pooled it
- The effects of on-screen, point of care computer reminders on processes and outcomes of care.The Cochrane database of systematic reviews · 2009Pooled it
- A systematic review on quality indicators for tight glycaemic control in critically ill patients: need for an unambiguous indicator reference subset.Critical care (London, England) · 2008Pooled it
- The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials.Journal of the American Medical Informatics Association : JAMIAPooled it
- Accuracy and reliability of a subcutaneous continuous glucose monitoring device in critically ill patients.Journal of clinical monitoring and computing · 2018Trial
- Insulin treatment guided by subcutaneous continuous glucose monitoring compared to frequent point-of-care measurement in critically ill patients: a randomized controlled trial.Critical care (London, England) · 2014Trial
- Data entry errors and design for model-based tight glycemic control in critical care.Journal of diabetes science and technology · 2012Trial
- Implementing glucose control in intensive care: a multicenter trial using statistical process control.Intensive care medicine · 2010Trial
- Intensive insulin therapy: enhanced Model Predictive Control algorithm versus standard care.Intensive care medicine · 2009Trial
- Article
- A Retrospective Cohort Analysis of Two Computerized Insulin Infusion Protocols.Journal of diabetes science and technology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo measure the impact of a computerized guideline for glucose regulation in an ICU.
designA randomized, controlled trial with an off-on-off design.
methodsWe implemented a glucose regulation guideline in an intensive care unit in paper form during the first study period. During the second period, the guideline was randomly applied in either paper or computerized form. In the third period, the guideline was available only in paper form. MEASUREMENTS AND
resultsWe analyzed data for 484 patients. During the intervention period, the control group included 54 patients and the computerized intervention group included 66 patients. The two guideline-related outcome measures consisted of compliance with: (a) glucose measurement timing recommendations and (b) insulin dose advice. We measured clinical impact as the proportion of time that glucose levels fell within target range. In the first (paper-based) study period, 29.0% of samples occurred with optimal timing; during the second period, this increased to 35.5% for paper-based and to 40.2% for computerized protocols. The third study period timeliness scores reverted to the first period rates. Late (suboptimal) sampling occurred for 66% of glucose measurements in the first study period, for 42% of paper-based and 28% of computer-based protocol samples in the second period, and for 50.0% of samples in the third study period. In the first study period, insulin-dosing guideline compliance was 56.3%; in the second period, it was 64.2% for paper-based and 77.3% for computer-based protocols, and it fell to 42.4% in the third period. For the second study period, the time that a patient's glucose values fell within target range improved for both the control (52.9%) and the computerized groups (54.2%) compared with the first study period (44.3%) and the third period (42.3%).
conclusionImplementing a computerized version of a guideline significantly improved timeliness of measurements and glucose level regulation for critically ill patients compared with implementing a paper-based version of the guideline.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.