Medicine and Health Sciences Commons^™

Evaluating The Effect Of An Electronic Health Record Patient Portal On The Management Of Hypertension, Ashley Hall

DNP Projects

Background: Hypertension is the leading cause of cardiovascular disease and affects individuals globally, nationally, and locally. Consequences of uncontrolled hypertension include atherosclerosis, heart failure, stroke, and renal disease. The electronic health portal is a patient-specific, interactive tool that has been shown to promote adherence to provider recommendations and improve chronic disease management.

Purpose: The purpose of this project was to determine the effects of education via an electronic healthcare portal on the blood pressure management of adults at a primary care clinic in a small town in Kentucky.

Methods: This study was a one-group pre/post intervention designed to evaluate provider …

Evaluating The Use Of Telehealth To Manage Hypertension In Primary Care, Alexandra M. Wiesner

DNP Projects

Background: Hypertension remains one of the most common chronic conditions in the United States leading to several health complications and immense financial burdens, yet it remains grossly undertreated despite the availability of evidence-based treatment options. The 2017 guidelines from the American College of Cardiology and American Heart Association recommended the use of home blood pressure monitoring with a telehealth component as an adjunct to regular hypertension treatment; however, implementing this into practice can be difficult depending on the setting, available resources, and the knowledge and skills of the providers. Aims: The purpose of this investigation is to evaluate patient adherence …

Evaluating The Sustainability Of A Colorectal Cancer Screening Improvement Intervention, Kimberly Bastin

DNP Projects

Background: Sustainability is a domain or characteristic of quality in healthcare that is not just about what may be delivered to patients today, but what can continue to be delivered to patients in the long term. Evidenced based interventions and quality improvement (QI) initiatives have led to major advancements in health care and have become expected in every clinical setting. Despite the amount of QI work taking place, there is limited evaluation of the sustainability of initially successful quality improvement efforts and a lack of evidence supporting best strategies and measures to ensure that improvement of goals and outcomes are …

Improving Tobacco Cessation Counseling Documentation In The Primary Care Setting, Brittany Roher

DNP Projects

BACKGROUND: Tobacco cessation counseling and documentation of the counseling is insufficient in many primary care settings across the United States. This can lead to care gaps such as missed opportunities for interventions appropriate to the level of readiness for change with regard to tobacco cessation. In addition, there is a potential for loss of revenue due to missed opportunities to provide a service and/or not capturing the service when provided. The Medicare Access and CHIP Reauthorization Act (MACRA) in 2015 started a new payment approach known as the merit-based incentive payment system (MIPS) which identified tobacco screening and cessation …

College Campus Outreach To Increase Chlamydia Screenings, Elizabeth Kinney

DNP Projects

A common sexual health concern around the world is sexually transmitted infections (STI). Chlamydia is the most reported sexual health problem. The highest prevalence of chlamydia rates is among ages 15-24, which includes college age students (CDC, 2019). The lack of education provided to students prior to starting college by parents, health care providers and high school sources as well as inaccurate information obtained from peers and erroneous internet sources may lead to misconceptions about STIs and consequently the avoidance of routine screening among this high-risk population (Canan & Jozkowski, 2017).

The purpose of this project was to determine if …

The Effect Of A Sun Damage Simulation Photography App On The Skin-Protective Behavior Intentions Of Women With Children Age 18 Or Younger, James Bowlds

DNP Projects

Abstract

Background: Skin cancer is the most common form of cancer diagnosed in the U.S. annually, despite being a largely preventable disease through the limitation of ultraviolet radiation exposure. Attempts to decrease its incidence have focused on appearance-based interventions. These have been effective at improving sun-protective behaviors among various subpopulations including people of color. Anecdotal observations suggest mothers more frequently utilize sun protection for their children than on themselves.

Purpose: The purpose of this project was to gain an understanding of the sun protection practices and beliefs of Caucasian and African American mothers, to assess the response to an appearance-based …

Evaluating Colorectal Cancer Screening Rates In An Urban Primary Care Practice, Kristen Makowski

DNP Projects

Colorectal cancer accounts for 8% of all cancer deaths and can be prevented through timely removal of colon polyps. Despite recommendations for routine screening, approximately 31.2% of patients go unscreened for this disease (Centers for Disease Control and Prevention, 2018). The purpose of this project was to determine screening rates and documentation mechanisms for colorectal cancer in an urban primary care practice, to determine how many patients completed the screening, and to present findings to the practice providers along with exploring ways to increase screenings. An additional purpose of this project was to determine and identify patient demographics which can …

Improving First Dose Administration Of The Hpv Vaccine For Adolescents In A Pediatric Primary Care Clinic, Scarlett Mikesell-Pierce

DNP Projects

BACKGROUND: Nationwide more than 90% of cervical cancer cases are caused by the human papilloma virus (HPV). Cervical cancer can be largely prevented by administration of the HPV vaccine for children before becoming sexually active. However, vaccination rates in the United States, remain low at 60%, and only 39.7% through series of completion, despite the strong evidence to support the effectiveness of the HPV vaccine. Research indicates a clinician’s recommendation, providing information and opportunity for discussion about the vaccine are strong motivators for parents to vaccinate their children, regardless of ethnicity. This study addresses the barriers to parent/caregiver intent to …

Improving Assessment, Documentation, And Ordering Of Diabetic Retinopathy Screenings In A Primary Care Clinic, Lauren N. Motto

DNP Projects

Abstract

BACKGROUND: Diabetes mellitus (DM) is the leading cause of new blindness in American adults. As the number of people with type 2 diabetes continues to increase, the total number of people affected by diabetic retinopathy (DR) will continue to rise. Improved access to screening for DR, followed by treatment, if necessary, can reduce the progression to vision loss. Despite national recommendations, less than half of Americans with DM complete annual diabetic retinopathy screenings (DRS).

PURPOSE: The purpose of this project was to improve assessment, education, documentation, and ordering of DRS for patients with a diagnosis of type 1 and/or …

The Effect Of A Patient Navigator Strategy On Colorectal Cancer Screening Completion In A Women’S Health Clinic, Martha Rosenthal

DNP Projects

Abstract

BACKGROUND: Colorectal cancer is the second leading cause of cancer related death in the US. Kentucky has one of the highest rates of the disease. Approximately 1/3 of the population has not completed screening for colon cancer as recommended by guidelines. Patient navigation is a strategy proposed to increase completion of screening in the primary care setting.

PURPOSE: The purpose of this quality improvement pilot project was to provide preliminary data on the impact of a patient navigation strategy to improve colon cancer screening completion in low risk individuals.

METHODS: Colon cancer screening completion using Colonoscopy or Cologuard testing …

The Effect Of A Provider-Based Educational Program On Knowledge, Attitudes, Self-Efficacy, And Order Rates Of Cologuard® In A Primary Care Clinic, Cassilly B. Besten

DNP Projects

BACKGROUND: Colorectal cancer is one of the most common and deadly cancers, particularly in persons greater than 50 years of age. Most colorectal malignancies are slow-growing, making regular screening increasingly important to decrease morbidity, mortality, and cost of treatment. Cologuard® serves as an effective and non-invasive colorectal cancer screening modality for average-risk adults.

PURPOSE: The purpose of this study was to evaluate the impact of a provider-based educational intervention on the knowledge, attitudes, self-efficacy, and ordering rates of Cologuard® among primary care providers.

METHODS: This study was a single-center, pre/post implementation study of the effectiveness of a provider-based educational intervention …

Evaluation Of An Online Lgbtq Patient Care Education Module For Primary Care Providers, Anthony C. Carney

DNP Projects

PURPOSE:

The purpose of this pilot study was to evaluate the effectiveness of an online educational module about LGBTQ healthcare topics for primary care providers in Kentucky. The study focused on the changes in knowledge, attitudes and self-efficacy in topics related to LGBTQ patients.

METHODS:

This study was a one-group pre/post intervention design to evaluate the knowledge, attitudes and self- efficacy of providers regarding primary care topics for the LGBTQ community before and after completing a training module on LGBTQ healthcare topics. Subjects were recruited via the KCNPNM Listserv over a 2-week period to participate in the interactive, online audio/visual …

Evaluating Depression Management In Primary Care, Danica Amos

DNP Projects

Background: Within primary care patients identified with depression often do not receive appropriate care (43%). Guidelines recommend combining pharmacotherapy and psychotherapy when possible and establishing follow up with patients to improve their response to treatment According to the APA, only 10% of patients receive combination therapy.

Purpose: The purpose of this study was to evaluate depression management practices in a primary care clinic, describe providers’ attitudes and skills related to depression treatment, and work with the healthcare team to identify strategies to improve depression management within the clinic.

Methods: A single site, descriptive study utilized a retrospective chart review of …

Evaluation Of A Diabetic Point Of Care Education In Primary Care, Mary Cho

DNP Projects

BACKGROUND: Diabetes education is the cornerstone of managing diabetes. The education can be delivered in group or individual sessions. Given that group classes are not always well received, a brief five-minute point of care education was developed and incorporated into patients’ routine diabetic appointment. The effectiveness of the method is yet to be determined.

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) project was to evaluate the effectiveness and acceptability of a recently implemented diabetes point of care education as compared to patients’ usual care in an urban primary care clinic.

METHODS: An outcome evaluation using a retrospective …

Evaluation Of An Intervention To Improve Screening For Substance Misuse Among 12-21 Year-Old Patients In A Rural Emergency Department, Peyton Blanton

DNP Projects

Background: In 2014, over two million children between the ages of 12-17 years of age admitted to using illicit drugs (2.3 million) and alcohol (2.9 million) in the past month. The younger a person begins misusing substances the more likely they are to have serious health consequences. It is imperative that we screen, detect, and intervene early to decrease the burden of substance misuse and addiction. Screening Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based strategy used to identify adolescents who misuse substances. The CRAFFT tool is recommended for screening adolescents for substance misuse.

Purpose: The goal of …

The Effect Of Provider Education On Copd Screening Rates In The Primary Care Setting, Kelli Craig

DNP Projects

BACKGROUND: Chronic Obstructive Pulmonary Disease is one of the leading causes of morbidity and mortality in the United States. With early detection, COPD is a treatable disease, highlighting the need for an effective screening measure. The COPD Population Screener Questionnaire (COPD-PS) is a valid, accurate questionnaire that can identify individuals likely to have COPD.

PURPOSE: The purpose of this study was to evaluate the impact of a provider-based educational intervention on the knowledge, attitudes, self-efficacy and screening rates of COPD using the COPD-PS screening tool among primary care providers.

METHODS: This study was a single-center, pre/post implementation study to evaluate …

A Survey Of Providers And Patients Assessing The Need For And Use Of Prevention Practitioners To Combat Obesity In The Primary Care Setting, Amanda R. Lyons

DNP Projects

Purpose: The overall aim of this project was to gather information from two groups of stakeholders, providers and patients, on the feasibility of implementing prevention practitioners in the primary care system to address overweight and obesity.

Methods: This study utilized a quantitative descriptive design through the use of electronic surveys. Provider surveys were explained and presented during a monthly provider meeting. Patient flyers were posted in exam rooms and surveys were accessible through a provided link and QR code.

Results: Providers (N=10) agreed that they saw a need for the use of a prevention practitioner (Mean=4.44, SD=.88) as well as …

Increasing Smoking History Documentation And Lung Cancer Screening Orders In A Primary Care Clinic, Tabitha M. Caudill

DNP Projects

BACKGROUND: In 2018, there were approximately 234,030 new lung cancer diagnoses and 154,500 lung cancer deaths in the United States. Kentucky leads the nation in new lung cancer cases each year. The USPSTF estimates that 10% to 12% of lung cancers detected by routine screening would not have been detected until the cancer advanced; therefore, the USPSTF recommends yearly lung cancer screenings using low dose CT (LDCT) scans of the chest for patients 55 to 80 years old who have a 30 pack-year smoking history and are currently smoking or have quit within the last 15 years.

PURPOSE: …

Evaluating The Feasibility Of Outpatient Iv Diuretic Therapy For Patients With Decompensated Heart Failure, Christina Thompson

DNP Projects

Heart failure is a prevalent chronic disease that contributes to many hospitalizations that may not always be necessary. Evidence supports that patients who present to the Emergency Department in fluid overload can be treated in the outpatient setting when only IV diuretic is warranted. Both decreases in costs and improved outcomes have been reported, yet there has been little movement toward providing outpatient diuresis versus hospitalization. The purpose of this DNP project was to evaluate the feasibility of an outpatient option for IV diuretic therapy for patients with acute decompensated heart failure experiencing symptoms of fluid overload. This descriptive study …

Advance Directives For Older Adults In Primary Care: An Intervention To Promote Screening And Documentation, Kathryn Bower

DNP Projects

Background: Advance care planning is the process of making decisions about the healthcare one wishes to receive should they become unable to make decisions for themselves, including the development of advance directives and designation of health care surrogates. Advance care planning is universally supported by governing bodies and professional organizations; however, less than one-third of Americans have an advance directive or designated health care surrogate.

Purpose: The purpose of this project was to assess primary care provider attitudes and knowledge of advance care planning and to increase screening for and documentation of advance directives and/or health care surrogates …

Evaluation Of The Effect Of Milner-Fenwick Video-Based Education And Teach-Back On Knowledge Acquisition In Atrial Fibrillation Patients, Melissa Czarapata

DNP Projects

PURPOSE: The purpose of this study was to evaluate if video education impacts knowledge acquisition and health literacy in patients with atrial fibrillation. METHODS: This study employed a descriptive, pretest-posttest single site comparative design. Baseline health literacy was assessed before video education was completed using the Atrial Fibrillation Knowledge scale. Health literacy regarding atrial fibrillation was again assessed for the same participants immediately after video education was completed and again in 7 to 10 days through the use of the Atrial Fibrillation Knowledge scale and teach-back questions. RESULTS: There was no statistical significance found when comparing scores before and after …

Screening For Alcohol Use, Misuse, Or Abuse In The Primary Care Setting Using The Audit-C Tool: An Extension Study, Courtney Amanda Minnis

DNP Projects

Abstract

PURPOSE: The purpose of this study was to improve alcohol screening rates in one primary care setting by educating and supporting providers and office staff on the use of the Audit-C alcohol screening tool.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected utilizing a retrospective chart review from the electronic medical records of adults over age 18 years by visit type: New Patient Visit, Annual Visit, or Employee Wellness Exam. Data included: demographic data of patient age, race, gender, the Audit-C score, and whether or not an intervention was performed.

RESULTS: Five providers …

Incidence And Treatment Of Acute Sinusitis In Two Outpatient Primary Care Settings And Provider Challenges In Treating Adult Sinusitis, Britney Nicole Perkins

DNP Projects

Abstract

BACKGROUND: Nationally, approximately one third of antibiotics are currently being prescribed unnecessarily. Antibiotic misuse can result in disability, longer hospital stays, increased costs to organizations, antibiotic resistance and death.

PURPOSE: The purpose of this project was two-fold: (1) explore current management of acute adult rhinosinusitis in an outpatient setting (2) assessing providers perceptions on the barriers to preventing antibiotic misuse.

METHODS: A retrospective chart review of 150 charts was performed to examine prescribing practices by providers treating rhinosinusitis at two primary care practices. An interview was conducted with the practice providers on barriers for compliance in antibiotic stewardship.

RESULTS: …

Evaluation Of Emergency Department Use By Adult Patients With Established Primary Care Provider, Sherry Tolentino

DNP Projects

BACKGROUND: Overutilization of the Emergency Department (ED) contributes to the unnecessary use of healthcare resources. One common cause is related to barriers to Primary Care access. Patients use the ED for conditions that can be managed in primary care due to the perception of urgency and convenience.

PURPOSE: The purpose of this project was to evaluate factors contributing to the use of the ED for adult patients with primary care providers (PCP). METHODS: A retrospective chart review was completed on 280 randomly selected patients over the age of 18 who presented to the ED between January and June 2018. Only …

Evaluation Of Depression Screening By Providers For Adult Patients With Type 2 Diabetes In Primary Care, Kristy M. Bryant

DNP Projects

BACKGROUND: Depression in adults with type 2 diabetes can lead to non-adherence to self-management behaviors and treatment recommendations, and ultimately worse health outcomes. Currently, only 50% of adult patients with type 2 diabetes treated in the primary care setting are screened for depression. Without screening for depression, a diagnosis of depression and subsequent treatment is likely to be missed and the patient is more likely to experience worse health outcomes and worse quality of life.

PURPOSE: The purpose of this study was to evaluate impact of provider education on improving screening rates for depression in adult patients with type 2 …

Health Literacy In A Primary Care Setting, Ashley Newman

DNP Projects

BACKGROUND: Low health literacy is prevalent in the United States. As a result, the Agency for Healthcare Research and Quality (AHRQ) developed universal health literacy precautions to improve patient understanding of health information. Using universal precautions and specific tools, such as teach-back, has been shown to decrease morbidity and improve patient outcomes.

PURPOSE: The purpose of this quality improvement project is to assess provider knowledge of health literacy in a primary care setting. A secondary purpose is to assess the use of patient education material for patients with diabetes, hypertension, and hyperlipidemia that meet universal precautions.

METHODS: This study was …

An Evaluation Of Provider Adherence To Acute Bronchitis Quality Measures In Adults, Rachel L. Lazar

DNP Projects

Background: Acute bronchitis management continues to be mistreated. Evidence based practice guidelines do not support antibiotic therapy for the treatment of acute bronchitis. Providers are encouraged to prescribe antitussives, suppressants and inhaler medications for the treatment of acute bronchitis symptoms, including cough.

Objective: The overall objective of this project is to evaluate the management of adults diagnosed with acute bronchitis in a limited services clinic.

Methods: A retrospective chart review was conducted on patients in a limited services clinic. The chart review assessed patients aged 18-64 with a diagnosis of acute bronchitis from July 1, 2016- June 30, 2017.

Results: …

Improving Fall Risk Assessment And Documentation: A Qi Project, Ashley N. Kohari

DNP Projects

BACKGROUND: Unintentional falls commonly arise and can cause significant harm including fractures, head injuries, and death. Assessing each patient for falls and performing a fall risk assessment is recommended by the American Geriatrics Society and the Center for Disease Control and Prevention, and is mandated for institutional reimbursement. Fall risk assessment has been shown to decrease the rate of falls and healthcare costs.

PURPOSE: The purpose of this quality improvement project was to improve compliance for fall risk screening and documentation to meet MACRA requirements in a family medicine clinic.

OBJECTIVES: The objectives for this project were: 1. Conduct PDSA …

Evaluating The Relationship Between Tobacco Use And Pain Perception Using The Global Pain Scale (Gps) In Opioid Dependent Adults: A Retrospective Analysis, Kristina Robinson

DNP Projects

Background: Chronic pain, smoking, and opioid use, contribute to a significant economic burden in the United States. Chronic pain affects all aspects of life, and is influenced by the use of cigarettes and opioids alike. Researchers suggest that there is a higher use of cigarettes and opioids in individuals with chronic pain. Chronic pain can promote smoking and smokers are more likely to use opioids. With the evidence that patients who smoke a higher number of cigarettes per day report higher pain, it is possible that smoking may be a stress-reducing behavioral response related to pain. Moreover, higher frequency and …

Increasing Influenza Vaccination Rates In A Primary Care Clinic: A Quality Improvement Study, Cassandra R. Roshel

DNP Projects

Background

According to the most recent CDC statistics, the influenza virus kills between 12,000 and 56,000 people per year in the United States. Although influenza vaccination is recommended each year, only about half of all Americans are actually receiving the vaccine annually. The goal of this quality improvement project was to increase influenza vaccination rates at a large academic medical center in Kentucky. At baseline, there was no standardized screening protocol in place prior to this study.

Methods

This study implemented a pre-test post-test design to evaluate the impact of a process change intervention on vaccination status from September 1, …