Student Name

Capella University

NURS-FPX9030: Doctor of Nursing Practice Across the Lifespan III

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Submission Date

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Diabetes remains one of the greatest chronic diseases that is treated at the primary care level and requires continuous monitoring, planned follow-up, and patient education that is tailored to reduce complications and the burden of the illness. Among the adult diabetic patients within the project site, there is a lack of sufficient glycemic control, as illustrated by 42% of them having HbA1c levels above 9, which points to gaps in the continuity of care, the delivery of health education, and adherence to follow-up. The quality improvement project is informed by the PICOT question below: How can the implementation of the ADA diabetes follow-up protocol (I), compared to the existing practice (C) can influence the glycemic control (O) in 12 weeks (T), in a state of diabetes care in adults (P)? This project team suggests the possibility of adopting an evidence-based follow-up protocol to enhance the competency of the staff and, eventually, to enhance glycemic outcomes, hence proving the value of structured, collaborative, and sustainable practices with diabetes care.

The assessment below relates to a set of raw data, which was gathered in the process of a 12-week quality improvement (QI) project aimed at enhancing glycemic control among adult patients with type 2 diabetes (T2DM) in an outpatient primary care setting. The project team used the American Diabetes Association (ADA) suggested diabetes follow-up protocol and evaluated the effect on patient glycemic outcomes, staff clinical competency, patient follow-up compliance, and self-management behaviors. The data below are de-identified. The names of patients were substituted with the ID of the participants (P001-P020). Staff IDs (S001–S008) were used in place of staff names. No personally identifiable information (PII). The information was obtained by the electronic health record (EHR) system and competence assessment tools used by the clinic during the implementation.

Table 1

Patient Demographic Characteristics and Baseline HbA1c (N = 20)

Note. Study codes have been used to replace all patient identifiers. Some of them were self-reported, including age group, sex, race/ethnicity, and insurance type. Week 1 EHR records revealed T2DM duration and baseline HbA1c. T2DM = type 2 diabetes mellitus; HbA1c = hemoglobin A1c.

Table 2

Patient HbA1c Outcomes Across Measurement Time Points (N = 20)

Note.  The laboratory results, which were included in clinic EHR at Baseline (Week 1), Week 4, Week 8, and Week 12, were used to obtain values of HbA1c (percentages). Change score represents Week 12 HbA1c – Baseline HbA1c. Target achievement was set as: HbA1c < 7% ADA Standards of Care. HbA1c = hemoglobin A1c; ADA = American Diabetes Association.

Table 3

Patient Follow-Up Adherence and Visit Completion Data (N = 20)

Note. The 12-week implementation period was arranged to be followed up biweekly (6 visits per patient). Patients with transport or mobility limitations were provided with telehealth visits. Completion rate = completion visits/ 6, multiplying the result by 100.

Table 4

Nursing Staff Competency Assessment Results (N = 8)

Note. The validated diabetes management competency assessment instrument was taken at Week 1 and Week 8, which provided the pre-training and post-training scores. The pre-defined competency success criterion was a score >= 80%. Checklist completion demonstrates the proportions of visits by randomly audited patients where full fidelity documentation is made.

Table 5

Patient Self-Management Behavior Checklist — Week 12 (N = 20)

Note: Patients self-reported using the standardized self-management checklist at the Week 12 follow-up visit on self-management behaviors. Over the 12 weeks, the nursing staff were asked to rate patient involvement, responsiveness, and compliance on a 10-point scale and set the engagement score. Partial = behavior was not always and sometimes performed.

Table 6

Summary Statistics: Project Implementation Outcomes

Note. EHR data, competency assessment, and patient self-management checklists were summarised based on the data sources collected throughout the 12 weeks of implementation. HbA1c = hemoglobin A1c; T2DM = type 2 diabetes mellitus.

Data Collection Notes

EHR queries and standardized competency measurement and patient self-management checklists were used to prospectively gather data in three measurement intervals: baseline (Week 1), midpoint (Week 8), and post-intervention (Week 12). P004, P010, and P018 attended four visits (67% completion). Transportation barriers were encountered by these patients who received telehealth, yet refused or had connectivity problems. The data on HbA1c were on hand at three of the three time points through the in-person visits. The 20 audited patient records were checked against documentation. The ≥80% post-training threshold was not met by one of the staff members (S004); the staff member was given remedial coaching, and a follow-up assessment was planned. All the information included here was anonymised under the HIPAA requirements. The original records with patient names and medical record numbers are stored in encrypted and password-secured clinic servers found by the project team and preceptor.