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Impact of a Multidisciplinary Approach to Guideline Implementation in Diabetic Ketoacidosis

Permanante Medical Group Inc., North Fresno Street, North Fresno, California, natutie{at}lycos.com

Chantal C. Fletcher, MD

Department of Medicine, UCSF Fresno Medical Education Program, Fresno, California

Robert W. Tevendale, MD

Department of Medicine, UCSF Fresno Medical Education Program, Fresno, California

Sipho M. Munyaradzi, BSc Hons, MS

Medical Decision Support Department Community Medical Centers, Sierra Community Health Center, Fresno, California

Scott Elliot

Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa

Michael W. Peterson, MD

UCSF Fresno Medical Education Program, Fresno, California

Background. Faculty members developed diabetic ketoacidosis (DKA) guidelines based on the current American Diabetes Association guidelines. Objectives. To evaluate the impact of a multidisciplinary approach to implementing DKA guidelines on residents' knowledge, guideline compliance, and patient outcomes. Design. Longitudinal case-control study with 2 arms. Setting. University-affiliated teaching hospital in Fresno, California. Methods. A Web-based testing software (TestWare) was used for educational/ assessment testing before and after DKA guidelines implementation. Patients' charts were reviewed to determine the degree of guideline compliance, patient care charges, and length of stay before and after DKA guidelines introduction. Results. Testing scores improved from 48% to 54% correct answers after implementation of the guidelines (P = .06). Overall, guidelines compliance improved from 67% to 88% (P < .05). Conclusion. A multidisciplinary intervention including knowledge assessment, individualized education, and formal didactic teaching was effective at improving knowledge and guideline compliance in DKA for internal medicine residents. (Am J Med Qual 2008;23:47-55)

Key Words: DKA • Web-based testing • quality of patient care

American Journal of Medical Quality, Vol. 23, No. 1, 47-55 (2008)
DOI: 10.1177/1062860607311015


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