Digital Commons Network^™

Asthma And Peak Flow Assessments Based On Nhlbi Asthma Guidelines, Julia Gliceria Almario Regalado

Doctor of Nursing Practice (DNP) Projects

Background: Asthma exacerbations are consequences of poor asthma control. Asthma guidelines-grounded interventions can improve adherence to asthma guidelines and assessments in primary care settings. The goals of asthma management are to optimize asthma control, minimize the risk of asthma exacerbations, and minimize the adverse effects of asthma medications.

Local Problem: A primary care practice in Northern California had frequent office visits for acute asthma symptoms. Ongoing asthma control monitoring is a key performance indicator of high-quality asthma care.

Methods: The quality improvement evidence-based observational project examined the effectiveness of interventions. The pre-and post-survey assessments collected clinician knowledge and adherence, and …

Improving Depression Screening In Primary Care, Grace Wilson, Annmarie O'Connor

Doctor of Nursing Practice Projects

Depression remains an increasingly prevalent and underdiagnosed disorder affecting approximately 21 million adults in the United States with only 66% seeking treatment (NIMH, 2022). Untreated depression can lead to worsening mental and physical health which negatively impacts a person’s quality of life. The implementation of routine depression screening in primary care is recommended by the US Preventive Services Task Force (USPSTF) to improve early detection leading to improved outcomes (USPSTF, 2023). Despite increased depression prevalence and USPSTF recommendation, there remained an absence of routine depression screening in a primary care practice in Midwest Illinois which led to the development of …

Integrating Behavioral Health Into Family Medicine: Improving Access To Specialty Care Using A Collaborative Care Model, Christina Stephens

DNP Scholarly Projects

Primary care, an extensive of family medicine remains a key access point for patients entering the healthcare system. Accessing medical care and specialty psychiatric services is limited in rural communities. Patients often find exhaustive wait times, untimely referrals, and reliance on emergency services for crisis management. The primary care provider is able to help their community improve access to behavioral health care by using a collaborative approach. This quality improvement initiative used the framework produced by the AIMS Center at the University of Washington and adopted for use creating an 8-week intensive program in a family medical practice located in …

Examining The Impact And Implementation Of Protected Administrative Time On Provider Well-Being And Service Delivery Indicators Within A Multi-State Network Of Primary Care Medical Practices, Lauren Junge-Maughan

Electronic Theses and Dissertations

Background:

Primary care is integral to achieving high-quality health outcomes for the population and decreasing healthcare costs. However, primary care clinicians suffer from conflicting demands, impossible expectations, and burdensome processes. With burnout and mental fatigue increasing, leadership must find innovative programs to implement in their organizations. This mixed-methods research study assessed the impact of one such intervention, protected administrative time (PRAT), on improving provider well-being.

Purpose:

The first aim was to evaluate the association of PRAT on the service delivery indicators of primary care clinicians’ productivity, average appointments per day, patient satisfaction (likelihood to recommend), clinician time to the next …

Evaluation Of Nutritional Guidance From Providers For Patients With Type 2 Diabetes In A Primary Care Setting, Whitney Rice

DNP Projects

Background: Adherence to diet is a challenging part of managing type 2 diabetes mellitus (T2DM). Guidelines recommend including a registered dietician and/or a diabetes educator. While this is the gold standard, there are barriers to implementation in primary care. The Starting the Conversation (STC) diet recall tool can aid primary care providers (PCPs) in providing brief nutrition counseling for patients with T2DM. Purpose: To evaluate the perceptions and practices of PCPs regarding dietary education and documentation for patients with T2DM after provider education and initiation of the STC tool. Methods: This was a quality improvement project using a quasi-experimental pretest …

Education For Primary Care Providers On Advance Care Planning: A Systematic Literature Review, Lindsey Ward

DNP Qualifying Manuscripts

Background: Healthcare providers in primary care treat patients at various stages of life. As patients age, it becomes necessary for providers to support their older patients throughout the aging process and address patient care even into life’s end stages. Primary care providers (PCPs) are well-positioned to provide this support and can do so through incorporating end-of-life (EOL) conversations in practice. Such discussions are called advance care planning (ACP). Though PCPs can play a crucial role in their patients’ EOL care decisions, providers report their limited knowledge of ACP as a barrier to its application.Consequently, further education for providers on utilizing …

Use Of Electronic Health Record Reminders To Improve Primary Care Providers’ Colorectal Cancer Screening Recommendations., Terra Renee Schrembs

Doctor of Nursing Practice Papers

Background: Colorectal cancer (CRC) is the third most common worldwide cause of cancer morbidity and mortality. CRC mortality is preventable through regular screening. Electronic health record (EHR) reminders for providers can increase providers’ CRC screening recommendations and lead to earlier CRC diagnosis. According to the National Cancer Institute’s Screening and Risk Factors Report for Kentucky by County 2008-2010, 62.7% of adults in a rural Kentucky county aged 50-75 had completed a home based FOBT in the past two years or have ever had a colorectal endoscopy.

Purpose: The purpose of this DNP project was to implement and evaluate an …

Improving Prediabetes Screening, Diagnosis, And Referral To A Diabetes Prevention Program In The Primary Care Setting., Brittany Morguelan

Doctor of Nursing Practice Papers

Improving Prediabetes Screening, Diagnosis, and Referral to a Diabetes Prevention Program in the Primary Care Setting

Table of Contents

Abstract……………………………………………………………………………………………4

Background………………………………………………………………………………………..5

Purpose…………………………………………………………………………………………...10

Literature Review……………………………………………………………………………...…10

Conceptual Framework…………………………………………………………………………..15

Setting………………………………………………………………………………………...….17

Context…………………………………………………………………………………………..18

Procedures/Intervention…….……………………………………………………………………19

Ethical Considerations…..……………………………………………………………………….20

Measures…………………………………………………………………………………………20

Data Analysis……………………………………………...……………………………………..22

Results……………………………………………………………………………………………23

Discussion……………………………………………………………………………...………...26

References……………………………………………………………………………………….33

Appendix A: Implementation Timeline…………………………………………………………40

Appendix B: IROC Quality Improvement Leadership Approval Letter………………………...41

Appendix C: PCP Referral Process and Diabetes Prevention Program Referral Order………...42

Figure 1: Monthly Number of N-DPP EHR Referrals by PCPs…………………………………….43

Figure 2: Monthly Total PCP Screening HbA1c/FBG Orders vs. Monthly Results HbA1cs……44

Figure 3: Demographic Analysis: Patients with a Documented Prediabetes ICD-10 (R73.03/R73.0)………………………………………………………………………………………….45

Abstract

Background: Prediabetes is a …

Initiating A Childhood Obesity Screening Process In An Urban Pediatric Office, Kesha Thomas

Doctor of Nursing Practice Projects

Background: The benefit of identifying a pediatric patient with obesity is to prevent many chronic health conditions that can occur from diabetes. Pediatric patients can be at risk for prediabetes, low self-esteem, and musculoskeletal issues. The patients that are at higher risk for childhood obesity are African American and Hispanics.

Purpose: The Doctor of Nursing Practice project aims to identify a pediatric patient that is obese to make sure that the patient is assessed appropriately and to discuss an appropriate intervention for the patient. To make sure all pediatrics have an accurate height, weight, and A1C during their well-child visit. …

Improving Care For Children And Adolescents With Down Syndrome In The Military Health System, Katherine B. Arrogante

Doctor of Nursing Practice Final Manuscripts

Background: Down syndrome (DS) is the most common chromosomal disorder worldwide. In the United States, DS occurs in one out of every 700 births. Children with DS have an increased risk of developing serious health conditions. In the military health system, children with DS face many barriers such as frequent relocations and poor access to specialty care. Primary care providers (PCPs) do not consistently follow published guidelines for health supervision.

Purpose: This project aims to improve the care for pediatric patients with DS in the military health system by increasing the knowledge and confidence of PCPs.

Methodology: An educational program …

Telehealth Integration In Primary Care, Ashley Simons

Doctor of Nursing Practice Projects

Telehealth has been proven to be a useful and integral tool in primary care settings. Carlinville Family Health Care Clinic, a rural health clinic, has the current ability to conduct Telehealth visits but is not currently doing so. They have several programs available that are equipped with Telehealth capabilities. The physicians cite lack of education on these programs and lack of a standard streamlined practice for which program to use or how to use it.

According to the physicians in this practice, along with their patients, the use of Telehealth has multiple advantages. Because visits in this clinical are usually …

Use Of Anticipatory Guidelines In Late Infants And Toddlers 12 To 24 Months In Primary Care, Claire E. Eller

Doctor of Nursing Practice Projects

Anticipatory guidance is a well-known and utilized method that has been implemented in a majority of pediatric primary care offices. As the need for efficiency grows and increasing patient volumes climb, there is a growing need for strategies to provide this information effectively and efficiently. Prior evidence can be utilized to identify the most critical knowledge caregivers and parents will require. Our findings indicate safety, communication, nutrition, social development, and behavior as cornerstone topics for anticipatory guidance. To increase the volume of education provided to parents and caregivers, alternate methods beyond verbal discussion could be used. After gathering scientific literature …

Weight Loss Communication And Treatment In Primary Care, Courtney Russell, Sarah Puckett, Jessica Mcrill

Doctor of Nursing Practice Projects

Obesity is undertreated in the primary care setting as a single medical condition. Obese patients are higher risk for comorbid conditions including heart disease, hypertension, diabetes mellitus and stroke. There is no universal screening tool implemented in the primary care setting for obesity management. An extensive literature review was completed to identify barriers in the primary care settings for providers to treat obesity as a disease state, assess current practices for weight management in these settings, and to identify health behaviors of adult patients with obesity. This project implemented the Five A’s Communication Tool to identify patients willing to discuss …

Advanced Care Planning In Primary Care, Kaylee Beals, Amanda Merriman

Doctor of Nursing Practice Projects

In Illinois, the do-not-resuscitate (DNR) form that is legally binding in all healthcare facilities is known as the Practitioner Orders for Life-Sustaining Treatment (POLST) form. The Patient Self-Determination Act (PSDA) of 1991 mandates only certain facilities to discuss advanced care planning (ACP). Primary care offices are not included in this mandate. Therefore, no structured process exists for primary care providers to identify patients who may benefit from ACP discussions. The purpose of this Doctor of Nursing Practice (DNP) project was to initiate conversations about ACP with patients 55 years and older in a primary care office and complete POLST forms …

Improving Health Prevention Screening In A Rural Health Clinic, Shawn M. Mcnally

Culminating Experience Projects

Background: Health prevention screening has recently been highlighted in many initiatives from leading countries around the world. Breast cancer screening, cervical cancer screening and osteoporosis screenings are among the highest objectives for many of these initiatives as national health agencies focus on reducing morbidity and mortality by early detection.

Local problem: Baseline quality metrics reported for one clinic show the appropriate ordering of these health screenings is below the national benchmarks and the organizational benchmarks.

Methods: The project was designed as a quality improvement project based in a critical access region serving a rural population.

Interventions: The project intervention …

Recognizing Barriers In The Elderly Population And Increasing Access To Case Management Services, Loveleena Alex

Doctor of Nursing Practice Projects

Abstract

Implementing case management can lead to fewer hospitalizations in the elderly population. Barriers influencing the number of hospitalizations include low socioeconomic status, transportation needs, health literacy, financial strain, multiple comorbidities, underserved populations, medication availability, availability of community resources, and access to primary care. A review of the available literature revealed that by addressing these barriers in a primary care setting and implementing case management, the number of hospitalizations can be decreased and the quality of life in the elderly population can be improved. This quality improvement project implemented a screening and referral process for chronic care management in the …

Improving Utilization Of Clinical Pharmacy Services In A Health Professional Shortage Area, Samantha E. Tallman

Culminating Experience Projects

Background: Integration of clinical pharmacy specialists (CPS) into primary care has increased over the last decade. CPS are highly educated advanced practice providers and specialize in chronic disease and medication management, and offer additional support to both patients and PCPs. Despite their extensive training and expertise, the role of CPS is often unknown or misunderstood amongst PCPs and results in the underutilization of CPS services. As a result, referrals to their service remain low. The purpose of this quality improvement project is to increase referrals to embedded CPS and identify encounter types by associated diagnoses.

Objectives: Develop and implement a …

Improving Osteoporosis Screening Rates In A Rural Primary Care Clinic, Lindsay Marlatt

Culminating Experience Projects

Background and Objectives: Osteoporosis related fracture rates are high yet lack of screening and education on osteoporosis remains a significant problem. The United States Preventative Services Task Force (USPSTF) recommends bone mineral density testing in women ≥ 65 and in women aged 50-64, based on specific risk factors. Using a screening tool such as the simple calculated osteoporosis risk tool (SCORE) is beneficial in identifying individuals that should be referred for BMD testing. Screening for BMD using dual-energy absorptiometry (DXA) is the gold standard in predicting major fractures, allowing for timely intervention in the primary care setting. Consequently, a plan …

Type 2 Diabetes Nutrition: A Video-Based Education Approach, Erin Russell

Culminating Experience Projects

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease associated with life- threatening outcomes. To prevent such outcomes, people with diabetes must possess the knowledge and skills required to manage their chronic disease. Objectives: To evaluate the impact of video-based education (VBE) on participant Diabetes Self-Management Education Skills (DSMES). Methods: The experimental study was conducted in a primary care office in a Midwest state. A convenience sample of 55 participants was selected. Pre- and post-implementation surveys were administered to measure change in self-efficacy between DMSES scores after viewing the VBE intervention. The Wilcoxon Rank Sum test was performed using …

Implementation Of Collaborative Care Intervention Within A Fqhc To Achieve Uniform Data System (Uds) Measure Of Depression Remission, Rasha A. Kafi Msn, Rn, Fnp-C

Doctor of Nursing Practice Projects

Background: Depression is one of the most common and treatable mental health conditions. Untreated depression causes emotional suffering, reduced productivity, lost wages, increased comorbidity risks, and increased healthcare costs.

Purpose: The purpose of this project was to implement Collaborative Care Interventions (CCI) to achieve the Uniform Data System (UDS) Measure of Depression Remission.

Aims: The AIMS of this project were: (a) Increases the percentage of nursing staff compliance and completion of the educational training; (b) increases nursing staff knowledge of recognition of depression signs and symptoms, early identification of depression, and administration to all adult patients; (c) Increase the percentage …

Primary Care In Southern Illinois And Western Kentucky, Matthew J. Crabtree

Honors College Theses

There is a major physician shortage occurring across the United States as of 2023 and it is expected to get worse over the next five to ten years. A significant portion of the shortage is predicted to consist of primary care physicians in rural areas. Data on factors that affect primary care visits like rurality, household income, health insurance coverage, non-communicable disease, and primary care physician prevalence were analyzed from the regions of Southern Illinois and Western Kentucky. Health coverage was found to be average to above average in the two regions. However, almost all counties included in the study …

Using Clinical Workflow Assessment Frameworks For Process Improvement Of Patient-Provider Communication In A Primary Care Office, Madeline Morris

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

The purpose of this project was to assess the current workflow for addressing the needs of patients between face-to-face healthcare visits at a primary care clinic in Northern New England. The assessment served as a framework to inform recommendations for process improvement interventions. Workflow was mapped using Lean’s value stream map (VSM) tool. Observational data and retrospective chart review were performed to collect information on time to complete tasks, equipment used, and personnel involved in each patient request. Key patterns in workflow variation, guided by theoretical frameworks of system constraints, were identified. Finally, a team brainstorming session was organized with …

Improving Communication Between Community Care Settings And Primary Care, Kristin Morgan

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background

In older patients with more complex and chronic health concerns, consistency and continuity of care is essential. Patients often live in assisted living residences or independently with support from programs such as Support and Services at Home (SASH), so nurses are available to address concerns and assist with certain aspects of care. Effective inter-professional communication is essential, but communication of assessments and coordinating care with participants’ primary care providers is complex.

Purpose

Improve efficiency and clarity of care-related communication for patient and care team by developing a system that standardizes and streamlines workflow and addresses current concerns.

Methods

At …

Evaluating The Feasibility And Efficacy Of A Brief Motivational Interviewing Nutrition Intervention For Women With Type 2 Diabetes In Primary Care, Charlotte M. Adams

DNP Projects

Background: The American Diabetes Association recommends lifestyle modification to prevent and treat diabetes in their 2021 Standards of Medical Care in Diabetes. Evidence suggests that motivational interviewing (MI) is an effective intervention that clinicians can use to facilitate behavior change in patients with type two diabetes.

Purpose: The purpose of this project was to evaluate a brief motivational interviewing intervention that could be delivered by a PCP to provide individualized nutrition counseling for adult women with type two diabetes in a primary care clinic in Lexington, KY. This study was a continuation of a previous quality improvement project at this …

Evaluating Providers’ Knowledge, Attitudes, And Intentions Toward Utilizing First Post-Discharge Visit Checklist In Primary Care To Reduce Readmissions In Heart Failure Patients, Binu Bashyal

DNP Projects

Background and Significance: Heart failure (HF) affects approximately 6.2 million adults in the United States and 40 million people globally. HF is one of the leading causes of emergency department (ED) visits and hospitalizations in adults. Twenty percent of patients admitted for HF are readmitted within thirty days, and up to fifty percent are readmitted by six months. A First Post-Discharge Visit checklist could help mitigate the problem of readmission.

Purpose: The purpose of this DNP project was to evaluate primary care providers’ knowledge, attitudes, and intentions towards utilizing the First Post-Discharge Visit checklist to reduce hospital readmissions among …

Improving Access To Gender-Affirming Care: A Welcome Packet, Kelsey J. Rumley

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

BACKGROUND: Transgender and gender diverse (TGD) individuals face unique challenges in accessing healthcare such as stigma, bias, fear of rejection, limited access to providers, and lack of information on where to seek care. There is evidence that creating an inclusive clinic atmosphere improves access and leads to a more positive healthcare experience

AIMS: The global aim of this project is to improve access to gender-affirming care for students at a New England university. Specific aims were to assess stakeholder needs for content inclusion and develop a new patient welcome packet based on the needs assessment.

METHODS: The Plan Do Study …

Home-Based Primary Care In Patients With Dementia: Impact On Cost, Medication Use, And Patient Satisfaction, Megan O'Leary

Theses and Graduate Projects

Background: Individuals living with dementia deserve affordable, accessible, and effective healthcare. These patients often face barriers that make it difficult to consistently access traditional in office primary care. Home-based primary care (HBPC) holds the opportunity to bridge the gap between individuals with dementia and preventative healthcare resources.

Purpose: Dementia rates are increasing as the population ages, and additional research is needed to determine the optimal treatment model for individuals with dementia. This literature review evaluates if patients with dementia receive improved care with HBPC vs in office primary care through examining cost, medication use and compliance, and patient satisfaction.

Methods: …

Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr

Walden Dissertations and Doctoral Studies

AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …

Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr

Walden Dissertations and Doctoral Studies

AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …

Registered Nurse-Led Annual Wellness Visits In Rural Health Clinics: A Program Evaluation Of A New Role, Tina Switzer

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The passage of the Patient Portability and Affordable Care Act had a goal of increasing access for preventive care. The Medicare Annual Wellness Visit (AWV) has been a free yearly, comprehensive preventive care opportunity for most Medicare beneficiaries since 2011. Because of the time intensive nature of these visits, the overall national completion rate for them has been low as providers often perceive time and resource constraints. Registered Nurses (RNs) have the skill set to complete these visits with minimal provider involvement. Rural residents often face health care access barriers and outcome disparities, and Rural Health Clinics (RHCs) are a …