Implementation and Evaluation of an Inpatient Diabetes Superuser Education Program

The investigators will develop a novel diabetes prescriber superuser educational program focused on inpatient diabetes management for physicians, based on their input. The investigators will then examine the impact of the diabetes prescriber superuser program and an analogous diabetes nurse superuser program that is already developed on glycemic control and other outcomes in hospitalized patients with diabetes.

Both hyperglycemia and hypoglycemia in the hospital are associated with various adverse outcomes, including increased complications, length of stay, cost, and mortality. To address this issue, Johns Hopkins Hospital (JHH) established an Inpatient Glucose Management Program in 2006 to address hypoglycemia and hyperglycemia and to ensure safe, standardized care delivery for hospitalized patients with diabetes. To support nursing education and compliance with JHH glucose management policies, the diabetes nursing "superuser" program was initiated in January 2007 and was critical to implementing the hypoglycemia policy nursing interventions. Following the establishment of hospital-wide glucose management policies and order sets for hypoglycemia and hyperglycemia, the nursing diabetes "superuser" education program, and clinical decision support tools for prescribers, there was a significant and sustained reduction in the incidence of hypoglycemia (\~20%) over a 3-year time period. However, the incidence of severe hyperglycemia was not significantly reduced by these interventions, indicating a differential impact of the program on hyperglycemia compared to hypoglycemia. The investigators believe this disparity is due to the hypoglycemia policy being implemented by the nursing staff, whereas the hyperglycemia policy and order set are implemented by prescribers (e.g., housestaff and hospitalists). Given the success of the investigators nursing program's in contributing to sustained reduction in hypoglycemia, the investigators hypothesize that an analogous diabetes prescriber superuser program, targeting physicians, will be an effective educational approach to addressing persistent hyperglycemia. The investigators proposal (1) it seeks to improve diabetes treatment in the hospital, a routine and relevant healthcare setting and (2) it utilizes existing healthcare infrastructure integrated into all hospitals-nursing staff and physicians-making it practical, scalable, and sustainable in other health systems. The investigators have the following specific aims: (1) to develop the diabetes prescriber superuser educational curriculum through Johns Hopkins Health System (JHHS) stakeholder community engagement; (2) to refine and package the JHH diabetes nursing and prescriber superuser educational curricula into an electronic tool kit and disseminate it locally to the 3 JHHS hospitals, based on stakeholder feedback; and (3) to evaluate the impact of implementing the JHH diabetes nursing and prescriber superuser programs at 3 JHHS hospitals on glycemic clinical outcome measures (primary). The investigators will secondarily assess the program's impact on glycemic process and economic measures.

Eligibility Criteria:
Inclusion Criteria:

* Adult (\>18 years)
* non-obstetrical patients admitted to the medical services where housestaff and hospitalist superusers have been trained with Type 1 diabetes or Type 2 diabetes
* individuals with hospital-related hyperglycemia who do not carry a prior diabetes diagnosis

Exclusion Criteria:

* Adults (\>18 years) with diabetic ketoacidosis
* hyperosmolar coma
* diabetes with other coma.