Automated, Component-Level Assessment of a National Inpatient Diabetes Guideline: Adherence and Its Association with Hospitalization Complications Across Six Hospitals
- 1Ben Gurion University of the Negev
Abstract
ObjectiveTo measure adherence to a national inpatient hyperglycemia guideline at the level of its individual recommendations across a hospital network, to determine whether it changed after the guideline was issued, and to identify which recommendations track subsequent outcomes.
Materials and MethodsRetrospective multicenter study of 48,354 admissions among 29,577 adults with diabetes or inpatient hyperglycemia at six Israeli general hospitals, August 2022 to December 2025. Each of 14 recommendations was formalized as a quality assessment temporal pattern over knowledge-based temporal abstractions of the record, scored wherever it applied. Pre-post adherence was compared by Welch t-test with false discovery rate correction. Associations with 10 complications were estimated by bias-reduced logistic regression over 24-, 48-, and 72-hour windows, and by inverse probability of treatment weighting contrasting above-with at-or-below-median adherence.
ResultsAdherence ranged from near-universal admission and medication-management actions to substantial gaps in insulin management (means, 0.15-0.28). Overall adherence rose modestly after issue (0.682 to 0.703, P < .001), with marked inter-hospital heterogeneity.After weighting, above-median adherence carried 44% lower odds of 30-day mortality (odds ratio [OR], 0.557; 95% CI, 0.514-0.603), 82% lower odds of hyperglycemia (OR, 0.175) and 52% lower odds of severe hyperglycemia (OR, 0.485), against 20% higher odds of hypoglycemia (OR, 1.204).
DiscussionThe least-implemented recommendations were largely those whose adherence tracked outcomes: repeated insulin decisions spread across a stay, rather than discrete actions on admission.
ConclusionGuideline adherence can be assessed automatically and per-recommendation at national scale, identifying where fuller implementation would most plausibly matter.
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BibTeX
@misc{oded2026automated,
title = {{Automated, Component-Level Assessment of a National Inpatient Diabetes Guideline: Adherence and Its Association with Hospitalization Complications Across Six Hospitals}},
author = {S. Oded and Y. Shahar and E. Shalom and A. Bashkin and L. Saiegh and D. Cantrell and I. Wirsansky and M. Badarne and I. Barash and A. Cahn and I. Hochberg},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.26.26364069},
url = {https://www.medrxiv.org/content/10.64898/2026.09.26.26364069v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Automated, Component-Level Assessment of a National Inpatient Diabetes Guideline: Adherence and Its Association with Hospitalization Complications Across Six Hospitals
AU - S. Oded
AU - Y. Shahar
AU - E. Shalom
AU - A. Bashkin
AU - L. Saiegh
AU - D. Cantrell
AU - I. Wirsansky
AU - M. Badarne
AU - I. Barash
AU - A. Cahn
AU - I. Hochberg
PY - 2026
DA - 2026/09/26
PB - medRxiv
DO - 10.64898/2026.09.26.26364069
UR - https://www.medrxiv.org/content/10.64898/2026.09.26.26364069v1
AB - ObjectiveTo measure adherence to a national inpatient hyperglycemia guideline at the level of its individual recommendations across a hospital network, to determine whether it changed after the guideline was issued, and to identify which recommendations track subsequent outcomes. Materials and MethodsRetrospective multicenter study of 48,354 admissions among 29,577 adults with diabetes or inpatient hyperglycemia at six Israeli general hospitals, August 2022 to December 2025. Each of 14 recommendations was formalized as a quality assessment temporal pattern over knowledge-based temporal abstractions of the record, scored wherever it applied. Pre-post adherence was compared by Welch t-test with false discovery rate correction. Associations with 10 complications were estimated by bias-reduced logistic regression over 24-, 48-, and 72-hour windows, and by inverse probability of treatment weighting contrasting above-with at-or-below-median adherence. ResultsAdherence ranged from near-universal admission and medication-management actions to substantial gaps in insulin management (means, 0.15-0.28). Overall adherence rose modestly after issue (0.682 to 0.703, P < .001), with marked inter-hospital heterogeneity.After weighting, above-median adherence carried 44% lower odds of 30-day mortality (odds ratio [OR], 0.557; 95% CI, 0.514-0.603), 82% lower odds of hyperglycemia (OR, 0.175) and 52% lower odds of severe hyperglycemia (OR, 0.485), against 20% higher odds of hypoglycemia (OR, 1.204). DiscussionThe least-implemented recommendations were largely those whose adherence tracked outcomes: repeated insulin decisions spread across a stay, rather than discrete actions on admission. ConclusionGuideline adherence can be assessed automatically and per-recommendation at national scale, identifying where fuller implementation would most plausibly matter.
ER -