Medicine and Health Sciences Commons^™

Creating Equal Opportunities Through Developmental Screening At A Rural Health Clinic, Allison Honderd

Doctoral Projects

Background: 17% of United States children have a developmental delay, but only 2-3% receive early intervention referrals (Rice et al., 2014; Zablotsky et al., 2019). Standardized developmental screening improves developmental delay identification and early intervention referrals (Guervara et al., 2013; Lipkin et al., 2020).

Objectives: This project aimed to implement standardized developmental screening, refer positive screenings, and generate revenue through proper billing.

Methods: A 12-week quality improvement project was implemented with the M-CHAT and Ages and Stages Questionnaire (ASQ) through four PDSA cycles at a rural health clinic for 9, 18, and 24-month well-child checks. Data were analyzed through a …

Increasing Annual Retinal Exams Among Patients With Type 2 Diabetes, Afokoghene H. Odhu

Doctoral Projects

The Center for Disease Control and Prevention (CDC, 2017) reports that approximately 30 million people in the United States (US) have diabetes. Approximately 8 million have diabetes retinopathy (DR) (CDC, 2018). DR is the leading cause of vision impairment in type 2 diabetes patients. Left untreated, DR can result in loss of vision and blindness (Hernández, Simó-Servat, Bogdanov, & Simó, 2017). The US spends approximately $500 million dollars annually in the treatment of diabetes-related blindness (CDC, n.d.). Early detection and management of DR through tight glycemic control, aggressive blood pressure and lipid management is essential to preventing complications of the …

Process Improvement To Improve Quality Measures In A Rural Primary Care Clinic, Lucille Yurko Vanderwoude

Doctoral Projects

Health disparities are differences in health that increase the amount of sickness in certain parts of the population, these inequalities in health are directly influenced by social, economic and environmental status (Healthy People 2020, 2008). Individuals living in poverty, violence, or disability have less opportunity for good healthcare and often have higher rates of chronic disease. Rural geographic locations additionally fall under this category (Healthy People 2020, 2008). These disparities can result from decreased exercise, violence in living situations, and unhealthy diet choices or options (CDC, 2018). Research has shown that health disparities increase with a reduction of individual’s income …

Self-Monitoring Of Blood Pressure In Community – Dwelling Senior Adults, Laura N. Love

Doctoral Projects

Unregulated hypertension is a public health concern. Hypertension is a chronic disease affecting adults across the lifespan. Although hypertension is easy to diagnose and treat, rates of blood pressure control continue to be low (AHA, 2017). Because of this, it is imperative to employ novel strategies for blood pressure control; especially in high risk populations. The purpose of this evidence-based, project was to determine whether self-monitoring of blood pressure (SMBP) improves knowledge about hypertension, while also increasing the frequency of SMBP. Another outcome of interest was a reduction in mean systolic blood pressure for the cohort. The project enrolled participants …

A Policy Analysis Of Adult Lead Exposure Screening In Michigan, Omoyemi A. Idowu

Doctoral Projects

A growing body of scientific literature suggests that even at low levels, lead is an important, but often overlooked risk factor for cardiovascular disease mortality in adults. Through an initial literature review and organizational assessment, the DNP student was able to identify a potential gap between current research and policy guidelines related to adult lead exposure screening in the state of Michigan. The purpose of this policy analysis project was to examine current literature and policy guidelines related to lead exposure screening in the adult population in order to identify and analyze a potential gap that may be amenable to …

Extraction And Analysis Of Data For Fragility Fracture Patients To Help Determine The Likelihood Of Follow-Up With A West Michigan Fragility Fracture Service, Michael Joseph Lamphere

Doctoral Dissertations

Fragility fractures and secondary fractures are a large physical, financial, and emotional drain on the individuals and families affected. Improving post fragility fracture care and increasing follow-up rates with specialty services, such as a fracture liaison service, may promote post-fracture recovery and help prevent future fractures. The purpose of this doctoral project was to increase and improve post osteoporotic fracture care by increasing appropriate referrals and follow-up care. Patient data was retrieved and analyzed on 60 fragility fracture patients referred to a local fracture liaison service. The analysis found that patient gender, fracture site, and history of a previous fracture …

Comparison Of A Self-Audit Tool To Accrediting Health Care Agencies’ Standards Of Care In A Corrections Setting, Matthew C. Widerman

Doctoral Projects

Millions of individuals enter correctional facilities each year and require health services. Inmates are bound to a set of rules, wherein they are thought of as objects of surveillance, punishment, or rehabilitation, rather than as patients. In addition to standards of care defined by national accrediting bodies and state boards of practice, correctional facilities also have state laws that define expected health services for incarcerated persons. All health care providers have a responsibility to provide the highest quality care, but in prisons, patients are still inmates bound to correctional rules. Policies and procedures guide health care practices in correctional facilities, …

Prior Authorizations And Continued Treatment In Addiction Medicine, Wendy Hunting

Doctoral Projects

Introduction: Patients that require medication assisted treatment for opioid addiction can have their treatment delayed through the prior authorization process. A prior authorization is required by many insurance companies and can cause lengthy delays before the drug is approved. The two drugs that were considered for this project were Suboxone® (buprenorphine/naloxone) and Sublocade® (buprenorphine). These drugs are used for the treatment of opiate addiction. The proposed solution to the problem was to use quality improvement methods to implement a tracking and tickler system to improve the approval time from the insurance company.

Objectives: The project goal was to decrease the …

Evaluating The Effectiveness Of Diabetes Class: A Project To Improve Quality Metric Measures, Miriam O. Russell

Doctoral Projects

Background: Diabetes is a significant health issue worldwide. Its increasing prevalence globally and regionally has been documented. Consequently, complications have resulted in higher morbidity and mortality in patients with diabetes (Martin & Lipman, 2013). The lack of education on self-managing diabetes can lead to serious complications. An effective approach, including evaluating and enhancing diabetes education, is necessary to improve diabetes self-management (Johnson & Raterink, 2009).

Objectives: To provide evaluation of a diabetes education class through quality measures and create a toolkit that will enhance the impact on the current diabetes education class.

Methods: A retrospective chart review that analyzes five …

Implementing Use Of The Moss (Michigan Opioid Safety Score) Tool And Interventions To Reduce Opioid-Related Overdose Events In High Risk Patients, Michelle J. Kloss

Doctoral Projects

Opioids are among the most common pharmacological class of therapeutic medications prescribed to alleviate pain across all healthcare settings. However, opioid-related adverse events are a growing problem contributing to an increase in morbidity and mortality. Current hospital practice does not utilize a pre-opioid administration screening tool to assess patient risk of adverse events related to opioid administration. The implementation of the Michigan Opioid Safety Score (MOSS), an evidence-based risk assessment tool which utilizes patient characteristics as well as respiratory assessment for the prediction and early detection of opioid-induced adverse events. This quality improvement project evaluated the effectiveness of the MOSS …

Improving A Midwestern Community Mental Health Organization's Smoking Treatment Services For Individuals With Serious Mental Illness, Leah J. Magnuson

Doctoral Projects

Tobacco smoking is the leading cause of preventable death in the United States. Billions of dollars are lost yearly in direct and indirect healthcare costs as well as lost work productivity due to smoking. While smoking rates have declined among those of the general population, they remain high among those with serious mental illness (SMI). Many of those with SMI desire to quit and are able to quit smoking when they are provided with appropriate interventions and resources. It is recommended for those with SMI to receive combined interventions in the form of pharmacotherapy and cognitive behavioral therapy to help …

A Need For A Culturally Congruent Obesity Intervention At A Community Safety-Net Clinic, Claudia D. Rivera-Salas

Doctoral Projects

Background: Obesity is an epidemic in the United States which causes numerous chronic conditions and disproportionally impacts underserved populations. The removal of barriers that prevent active lifestyles such as unaffordable facilities and inaccessibility are of primary importance in promoting a healthy lifestyle.

Objectives: Collaboration with community organizations to increase access to culturally congruent nutrition and exercise classes for underserved Latino/Hispanic patients of a Midwestern safety-net clinic to reduce obesity, increase physical activity, and improve dietary habits.

Methods: Assessment of current practices revealed the need for project development. Six-week nutrition education class and exercise classes were held for eligible patients which …

Implementation Of The Vaccines For Children Program In A Midwest, Urban Clinic Dedicated To The Underserved Population, Akmal Saydazamov

Doctoral Projects

Background: Low immunization rates weaken herd immunity and endanger children. The Safety Net Health Clinic (SNHC) study site serves an underprivileged and refugee population with significantly lower than ideal coverage. Series completion disparities persisted after control for demographic, access-to-care, poverty and language effects (Varan et al, 2016).

Objectives: SNHC implemented the Vaccines for Children (VFC) program in order to increase the vaccination rates among the underserved population.

Methods: As an efficacy study, the project focused on three major areas in the VFC implementation – cost, staff preparedness and patient need. Cost was determined by utilizing electronic medical records (EMR) and …

Using Technology-Driven Patient Communication Appointment Reminders To Improve Uniform Data System Measures In A Federally Qualified Health Center, Ana Torres

Doctoral Projects

Background: Process of meeting Uniform Data System (UDS) measures in a west Michigan Federally Qualified Health Center (FQHC) has several components with different team members sharing responsibility in the process and workflow to document preventative screenings. An evidence-based technology-enhanced patient communication intervention was developed to meet benchmarks for the FQHCs UDS reporting metrics. The purpose of this quality improvement project was to answer the clinical question: Will technology-enhanced communication appointment reminders using automated telephone communication increase rates of screening follow-up visits to improve data reported to UDS at a west Michigan FQHC organization?

Objectives: Increase percentage of screening visits after …

Development Of A Process For Adoption And Attainment Of Pcmh Recognition Requirements For An Urban Primary Care Clinic, Jamie L. Hendricks

Doctoral Projects

The Centers for Disease Control and Prevention (2017) reported that in 2016, healthcare expenditures in the United States totaled 17.9% of the gross domestic product. Unfortunately, care quality is not reflective of the high costs of care. Models of care delivery like the patient centered medical home (PCMH) have shown promise in addressing these concerns.

This project focused on program development for PCMH adoption at an urban clinic in an effort to improve financial stability and remain competitive. The purpose was to propose a plan for adoption and attainment of PCMH recognition requirements for an urban primary care office.

The …

Screening For Social Determinants Of Health In Diabetic Patients Served In Primary Healthcare Centers, Hewan K. Chekol

Doctoral Projects

Background: Social Determinants of Health (SDOH), such as food, transportation, housing, and financial status, plays a significant role in a diabetic patient’s health care outcome. However, primary healthcare centers lack a systematic method of identifying patients with unmet social needs in order to provide appropriate referrals to community resources.

Objective: This project seeks to improve the screening methods of SDOH in a midwestern federally qualified primary healthcare center by incorporating an evidence based SDOH screening tool. This SDOH screening tool is tailored towards diabetic patients.

Method: Kotter’s Eight Step Change model guided the implementation process of this quality improvement project. …

Pathways To A Sustainable Community Health Worker Program In A Rural Native American Community, Hannah R. Duby

Doctoral Projects

Introduction: American Indian/Alaska Native (AI/AN) people have some of the greatest health disparities of any other citizen group in the U.S. (National Indian Health Board [NIHB], 2018). As liaisons between community members and health services, community health workers (CHWs) play an important role in reducing disparities in AI/AN communities (Indian Health Service [IHS], 2018). CHWs in the organization of interest are not being used to their full potential as the documentation of their care is not accessible to the primary care providers (PCPs) for care coordination and the program is threatened by issues related to sustainability.

Objectives: The purpose of …

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

Improving Adolescent Risk Behavior Screening: Implementation Of The I-Cloud Rapid Assessment Adolescent Preventive Screening (Raaps) Tool, Donna L. Rinker

Doctoral Projects

Adolescents are engaging in risky behaviors earlier contributing to 75% of adolescent morbidity and mortality with unintentional injuries listed as the most common cause of death among this population in the United States. It is reported that engaging in more than one risk behavior will lead to other risk behaviors resulting in the rise of indirect and direct costs in society today. The scholarly project was conducted in response to a midwestern Michigan primary care clinic need to improve the early identification and documentation of adolescent risk behaviors with evidence-based technology screening. The purpose of this quality improvement project was …

The Relationship Between Acculturation Level Of Mexican-American Parents And Coping With Their Chronically Ill Children, Nancy Ellen Tena

Masters Theses

This investigation focused on 19 Mexican-American families with neurologically impaired children to determine to what extent they selected particular coping patterns in relationship to their level of acculturation to the Anglo-American culture. Using the Acculturation Rating Scale for Mexican-Americans (ARSMA), the families were categorized according to acculturation level (low, bicultural, and high). The families identified coping patterns (Family Support, Social Support, and Medical Support) which were helpful to them by completing the Coping Health Inventory for Parents (CHIP). Only one statistically significant relationship between acculturation level of these families and extent of their use of coping patterns was found: high …