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Activity Number: 188
Type: Contributed
Date/Time: Monday, August 4, 2014 : 10:30 AM to 12:20 PM
Sponsor: Health Policy Statistics Section
Abstract #313611
Title: Using Instrumental Variable Regression to Explore Best Clinical Practices for Electronic Glucose Management Protocols for Non-Diabetics in an Adult Intensive Care Unit
Author(s): Justin Dickerson*+ and Michael Lanspa and Emily Wilson and John Holmen
Companies: Intermountain Medical Center and Intermountain Medical Center and Intermountain Medical Center and Intermountain Medical Center
Keywords: Instrumental Variables ; Glucose Management ; Clinical Practice ; Electronic Decision Support
Abstract:

Proposed electronic glucose protocol ranges are 80-110 mg/dl and 90-140 mg/dl for adult intensive care unit (ICU) patients. Relationship between the protocols and coefficient of glucose variation (COV) were analyzed with instrumental variable(IV) regression. Over 4,000 adult ICU records from Utah Valley Medical Center in Provo, Utah were examined. Selection criteria excluded those with diabetes and diabetic ketoacidosis. Physicians assigned patients to 80-110 mg/dl or 90-140 mg/dl targets. IVs were identified for use in a two-stage least squares IV regression model. Diagnostic tests were performed to screen for the need to model endogenous relationships, model over-identification, and residual correlation between IVs and COV. The final sample was n = 1,315. The first measured APACHE II score, a measure of patient injury, along with patient age were found to be the best IVs for the protocols (p < 0.001). The result of the IV model demonstrated a -0.078 point reduction in COV (p < 0.001) when the patient was treated under the 90-140 mg/dl protocol versus 80-110 mg/dl. Diagnostic tests were satisfied. IV methods could benefit ICUs collecting data for similar post-hoc analyses.


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