Medicine and Health Sciences Commons^™

A Crosswalk Protocol For Implementation Of The Patient-Centered Medical Home And Meaningful Use At A Midwest Nurse Managed Center, Kaitlyn Rath

Doctoral Projects

Healthcare expenditures in the United States far exceed the spending that occurs in other high-income countries (Squires & Anderson, 2015). However, the healthcare outcomes are poorer in the U.S. on multiple key health care measures including life expectancy and the prevalence of chronic illnesses and comorbid conditions (Squires & Anderson, 2015). New care models not only focus on improvement of key health outcomes, but also on healthcare providers to reduce fragmented care with care coordination. This DNP scholarly project addresses the need for financial stability within a Midwest nurse managed center. This center would benefit from utilization of a new …

Acceptability Of The Md Anderson Symptom Inventory And Qualitative Analysis Of Barriers To Palliative Care Services For Rural And Non-Rural Populations, Daniel M. W. Johnson

Doctoral Projects

The United States health system strives to improve the care patients receive while reducing healthcare expenditures. A significant portion of the nation’s healthcare expenditure is spent on end of life care. Palliative care provides one solution to reducing healthcare expenditures while improving the patient experience. Reducing symptom intensity is one example of palliative care’s success. A midwest palliative care program was tasked to gather quality data on the service’s ability to manage patient symptoms.

The program selected the MD Anderson Symptom Inventory to improve symptom assessment and provide quality metrics for the organization. Additionally, research suggests rural populations have poorer …

A Quality Improvement Program In A Safety Net Clinic Serving Vulnerable Populations, Kaitlin J. Hendriksma

Doctoral Projects

The Patient Protection and Affordable Care Act of 2010 resulted in major changes to healthcare infrastructure in the United States, with two main areas of concentration: healthcare financing and population health management. Quality improvement programs focus on improving healthcare quality for populations with conscious efforts to decrease healthcareassociated expenditures. Quality improvement interventions can include patient-reported outcomes, clinical decision support systems, and clinical dashboards. The purpose of the Doctor of Nursing Practice project was to formally implement a quality improvement program for chronic disease management in a safety net clinic serving vulnerable populations. The Donabedian model served as the conceptual model …

A Technical Integration Of Primary Care Into A Behavioral Health Site, Lara M. Dengerink-Vantil

Doctoral Projects

People with persistent mental illness experience more chronic disease and co-morbidities than the general population, impacting their quality of life and increasing the cost of health care. In spite of the increased need for primary care services, people with mental illness encounter barriers to health care including lack of access to care, and a shortage of both primary care and psychiatric care providers. While this challenge was previously addressed by attempting to integrate behavioral health care into primary care settings, recent research indicates that a more successful model is reversed shared care, or the integration of primary care into a …

The Design Of An Evidence-Based Protocol For Primary Care Of Patients With Dementia, Kaitlin B. Demaagd

Doctoral Projects

Improvement in the effectiveness and optimization of care outcomes for patients with dementia in primary care is a national priority (American Medical Association-convened Physician Consortium for Performance Improvement [PCPI], 2014). Alzheimer’s disease affects more than 5 million Americans. Patients with dementia cost the nation $236 billion in 2016 (Alzheimer’s Association, 2016). In 2014, the PCPI developed ten evidence-based recommendations to address the gaps in outpatient dementia care called the Dementia Performance Measure Set (DPMS). An independently owned, non-system affiliated primary care practice identified the need to improve the quality of care they provide to their patients with dementia and their …

Toolkit Development For A Community-Based Palliative Care Program, Tanya A. Rowerdink

Doctoral Projects

The quality of care in the U.S. at the end of life is poor, yet comes with a high price. Since the Institute of Medicine’s (IOM) report Approaching Death in 1997, inpatient palliative care programs in hospitals with 50 beds or more have grown by 165%. In 2015, the IOM had a follow up report, Dying in America that indicates the need for community-based palliative care programs to increase access of care for individuals who are homebound or live in rural communities. In January 2016, the Centers for Medicare and Medicaid Services (CMS) initiated the Medicare Care Choices Model (MCCM) …

A Quality Improvement Initiative To Enhance Nursing Teamwork: An Element Of Excellence, Jenna L. Stoll

Doctoral Projects

Health care is changing at a rapid pace to meet the needs and expectations of consumers across the United States. The desire for improved quality of care while reducing costs has led to increased attention on team composition, relationships, and culture. There is growing evidence to support the importance of quality workplace relationships and teamwork (Brunetto et al., 2013). Research indicates a positive relationship between a culture of teamwork and quality performance measures in the health care setting (Meterko, Mohr, & Young, 2004).

Teamwork in the acute inpatient care nursing team deserves more attention (Kalisch, Lee, & Rochman, 2010). Evidence …

Lgbt Client Satisfaction At A University-Associated Primary Care Center, Christopher M. Bouma

Doctoral Projects

Sexual minority individuals are a vulnerable population. Historically this has led to worse access to care and worse health outcomes compared to heterosexual individuals; this can be addressed through changes to practice. Patient satisfaction has also been a health care focus in recent years for all patients. This project examined patient satisfaction in a small university-associated primary care center and compared patient satisfaction scores for sexual minorities to heterosexual respondents. This was conducted after a series of lesbian, gay, bisexual, and transgender (LGBT) educational initiatives with center staff. A total of 73 individuals chose to participate. Most individuals were highly …

Identification Of Nonalcoholic Fatty Liver Disease In Patients With Hepatitis C: Using Evidence Based Guidelines To Improve Diagnosis And Transition Of Care From Specialty Care Provider To Primary Care Provider, Debra B. Bayus

Doctoral Projects

Chronic liver disease is a process that involves progressive destruction and regeneration of the liver causing fibrosis, cirrhosis and hepatocellular carcinoma, and early death. Persons with chronic liver disease treated for hepatitis C with abnormal radiological imaging consistent with increased fat content in the liver (hepatic steatosis) should be evaluated for nonalcoholic fatty liver disease (NAFLD). However, individuals treated at a community hepatitis C treatment clinic are currently not being evaluated for NAFLD. In addition, if NAFLD is diagnosed, management of these co-occurring conditions is required to delay disease progression. Factors contributing to gaps in NAFLD care include: poor communication, …

Implementing Spirometry-Driven Evidence-Based Asthma Care In A Primary Care Practice, Douglas C. Rau

Doctoral Projects

This project was a quality improvement initiative employing an educational intervention to increase the awareness and stress the importance of utilizing spirometry in the diagnosis, treatment, and management of asthma. Clinical support staff received training on how to perform spirometry and providers received education on the interpretation and utility of spirometry results to drive care to improve outcomes for clients with asthma. Project outcomes examined the self-rated confidence to perform and interpret spirometry before and after the intervention and the subsequent utilization pattern of office-based spirometry at the primary care clinic. For clinical support staff, the self-comfort level at performing …

Population Health Management Risk Assessment Tool Validation: Directing Resource Utilization, Sonya L. Christensen

Doctoral Projects

The Affordable Care Act (ACA) of 2010 is transforming health care across the nation into a value-based system that emphasizes quality and continuity with reimbursement tied to patient outcomes. The shift in emphasis is best realized through the strategy of Population Health Management, a change from traditional episodic treatment of illness to management of the health needs of populations throughout the continuum of health. The goal of care is to ensure that patients, especially the chronically ill, receive effective attention to their health needs in order to improve outcomes, decrease costs, and provide a positive patient experience. An important component …

Implementation Of A Smart Goal Intervention For Diabetic Patients: A Practice Change In Primary Care, Mackenzie Swanson

Doctoral Projects

Self-management techniques have been shown to be useful practice tools for providers managing patients with chronic disease. One valuable aspect of self-management is goal setting, whereby the patient is directed to create highly attainable personal goals to modify a selected behavior. Through the attainment of these goals, the patient begins to experience confidence and improved self-efficacy in managing chronic diseases such as diabetes. This paper provides background on the use of SMART goals for diabetic patients, how this practice change supports Meaningful Use objectives and helps meet the requirements for future reimbursement opportunities. A thorough organizational assessment of a Midwest …

Health Literacy Assessment And The Meaningful Use Incentive Of Providing Clinical Summaries In An Underserved, Hypertensive Population, Tami Pettenger

Doctoral Projects

Hypertension is a common diagnosis in the United States and can lead to health complications if not well managed. However, this condition often has few to no symptoms which may lead patients to modify, disregard, or otherwise be non-adherent to treatment plans. Also a patient’s health literacy level may directly affect his or her ability to understand and act on health information. This may be especially true in vulnerable populations such as older adults and underserved communities. In addition, the education material provided to patients, such as clinical summaries following a health visit, may not be consistent or understandable or …

Quality Improvement Initiative In Transplant Diabetes Care: Needs Assessment And Protocol Development, Dawn Korson

Doctoral Projects

Over 30,000 people receive a solid organ transplant each year, with 5-30% developing post-transplant diabetes mellitus (PTDM) (United Networking for Organ Sharing, 2015). At a Midwestern transplantation center, over 22% of patients with a history of diabetes were not consulted to endocrinology after kidney and liver transplantation. With poor glycemic control, there is an increased risk of developing PTDM leading to poor outcomes. Utilizing the Donabedian model and the Six Sigma’s Define, Measure, Analyze, Improve, and Control (DMAIC) as guides for implementation, the purpose of this project was to address the process measures of increasing appropriate consultations for evaluation and …

Evaluating The Effectiveness Of An Exercise Program For Persons With Multiple Sclerosis, Tiffany Kuipers

Doctoral Projects

Multiple sclerosis (MS) is a chronic, degenerative condition of the central nervous system that leaves patients with a wide variety of symptoms and disability. Symptoms include decreases in energy levels, muscle strength, bone strength, vision, sensation, coordination, cognition, hearing, balance, and quality of life. Exercise has been well supported as a way to reduce symptoms and slow the disease progression of MS. Outpatient exercise programs have also been shown effective in providing patients with the necessary tools to perform appropriate exercises at home. Yet, few programs are available that are appropriate for patients with MS. This project aimed to, first, …

Screening Initiative For Non-Stroke Geriatric Inpatients, Kimberly Harper

Doctoral Projects

Current literature reveals a need for improved depression screening efforts among inpatient geriatrics. This population is at higher risk for severe depression, suicidal ideations, poorer health outcomes related to decreased compliance to healthcare regimens, and increased healthcare costs. Current best practice involves the utilization of the Geriatric Depression Scale-Short Form (GDS-SF), a 15-question yes or no answer screening tool. While not diagnostic, the tool has established validity and reliability testing. The GDS-SF should not be used on subsets of the population diagnosed with stroke, dementia or delirium.

The purpose of this project was to develop a protocol for implementation of …

Use Of Culturally Tailored Media To Increase Hiv Screening Among African Americans, Leda Evans

Doctoral Projects

Over one million people in the United States have HIV with a substantial portion of these individuals being African American. Innovative approaches to improving the HIV disparity among African Americans have been encouraged by the federal government. Culturally tailored HIV risk reduction interventions have been noted as effective in several studies in reducing risk behavior. The purpose of the intervention was to determine if the use of culturally tailored HIV risk reduction media would result in an increase in HIV screening among African Americans. A one-time community based-intervention with no control group was utilized to determine impact of media. Screening …

Development Of A Toolkit To Evaluate Efficacy Of The Respecting Choices© System Of Advance Care Planning, Nicole M. Harpold

Doctoral Projects

In 1991 the United States Congress enacted the Patient Self-Determination Act which was an attempt by the government to improve completion rates of advance directives. Despite enactment of this law, completion rates of advance directives have remained relatively unchanged with only 18-36% of adult Americans having completed a document (United States Department of Health and Human Services, 2008). Nearly 90% of healthcare spending in the United States is on the management of chronic conditions (Centers for Disease Control and Prevention, 2015). As the baby boomer generation, which already has a high number of chronic conditions, ages our struggling healthcare system …

Evaluating The Use Of The Asthma Action Plan And The Asthma Control Test By Providers In A Primary Care Office After Implementation Into The Electronic Health Record, Claudia N. Turkson-Ocran

Doctoral Projects

Asthma is a life-long chronic lung disease that inflames and narrows a person’s airway. Asthma results in recurring periods of chest tightness, wheezing with inspiration and/or expiration, shortness of breath, nighttime or early morning coughing, and trouble sleeping as a result of coughing and wheezing. An asthma exacerbation occurs when asthma symptoms worsen enough to require medical intervention or self-administration of oral corticosteroids. Exacerbations can be graded in severity as mild, moderate, severe, and life threatening. An asthma action plan (AAP) is a written treatment plan developed collaboratively between the health care professional and the patient for self-management and maintenance …

A Standardized Palliative Care Referral Workflow And Educational In-Service At An Outpatient Congestive Heart Failure Clinic, Rachel E. Cardosa

Doctoral Projects

Cardiovascular disease is a significant health issue in the US as it is the leading cause of death and most cited reason of hospitalizations in Medicare enrollees (Centers for Disease Control, 2014; Unroe et al., 2011). The American Colleges of Cardiology and the American Heart Association Guidelines recommend palliative care for all patients with heart failure (Yancy et al., 2013). The purpose of the scholarly project was to address the gaps in current practice by creating a standardized palliative care referral process and education for clinicians in an outpatient Advanced Congestive Heart Failure (ACHF) Clinic. A referral tracking process was …

Development Of A Protocol For Implementing The Medicare Annual Wellness Visit In A Primary Care Setting, Jennifer M. Ohman

Doctoral Projects

The Medicare Annual Wellness Visit (AWV) was enacted in 2011 as part of the Patient Protection and Affordable Care Act. The AWV is an opportunity to improve care delivery by encouraging use of preventive services and coordinate care for Medicare patients 65 and older who are at high risk for high usage of healthcare services. During this visit, patients are screened for common geriatric-related conditions such as depression, cognitive impairment, fall risk, and functional decline. This visit is also an opportunity to identify risk factors for chronic illness and help patients stay current on recommended screenings and vaccinations. The organization …

Communication Process Improvement Among Bedside Nursing Staff On A Skilled Nursing Rehabilitation Unit, Lauren Dice Smith

Doctoral Projects

Communication in healthcare is pivotal for transferring patient clinical information. Communication is important between and within disciplines and throughout the continuum of care. Poor communication has been found to be the third leading root cause of sentinel events (event which may cause death, permanent harm, or severe temporary harm) within hospitals behind human factors and leadership. Standardization of nursing handoffs using the Situation Background Assessment Recommendation (SBAR) model and conducting the handoff at the patient’s bedside have produced positive outcomes including improving patient safety, improving nursing and patient satisfaction, and increasing time efficiency for nurses. The PICO question for this …

Severe Mental Illness In Adults And Physical Health Outcomes, Kathryn L. Speeter

Doctoral Projects

Adults with severe mental illness (SMI) experience higher morbidity and mortality rates than the general population due to poor physical health and because physical and psychiatric health are rarely addressed holistically. Two questions were posed for this project: (a) Will the use of a physical health screening tool and development of healthpromotion goals result in a change in healthy lifestyle behaviors for participants? (b) Will case managers see value in the use of the screening tool and health-promotion action plan development and incorporate the tool into their day-to-day work with clients? Fourteen adults with SMI, from a community case management …