Primary Care Commons^™

Refugees' Perceptions Of Primary Care: What Makes A Good Doctor's Visit?, Anne Mutitu, Bev Zabler, Jeana M. Holt

Patient Experience Journal

Redesigning primary care is a national priority, as the United States (US) struggles with issues of poor access, high cost, and suboptimal quality. Refugees are among the populations who suffer from America’s disjointed health care system, resulting in disproportionate health disparities. Although there are many studies on refugee health, few share refugees' perceptions of primary care. We asked local refugees who were seen for primary care services at a midwestern academic nurse-led clinic, what makes a good doctor's visit?  The clinic served as the hub of a federally funded refugee Community Centered Health Home (CCHH) pilot project. This qualitative study …

Increasing Rates Of Larc Uptake And Continuation Through Contraceptive Counseling: An Effective Approach For Women With Underutilization, Malia Johnson

DNP Qualifying Manuscripts

Unintended pregnancies in women with a substance use disorder are estimated to be nearly double that of the general population, of which negative health consequences are increased for both mother and neonate. Unintended pregnancies are preventable through the use of highly effective contraception that is less susceptible to the effects of typical versus perfect use. Long-acting reversible contraception (LARC) is ideal for this patient population. Therefore, a thorough literature review was performed to evaluate the role of contraceptive counseling on LARC uptake and continuation among women. The results indicated that contraceptive counseling does influence LARC uptake and continuation and it …

House Calls Are Reaching The Tipping Point — Now We Need The Workforce, Thomas Cornwell

Journal of Patient-Centered Research and Reviews

Home-based primary care (HBPC) improves the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of HBPC, and improved payments for HBPC. There are 2 million to 4 million patients who could benefit from HBPC, but only 12% are receiving it. The number of these patients is expected to double over the next two decades. This requires a larger and better …

Incorporating Home Visits In A Primary Care Residency Clinic: The Patient And Physician Experience, Mary Caitlin St. Clair, Jessica J. F. Kram, Glenda Sundberg

Journal of Patient-Centered Research and Reviews

Purpose: Home visits, once a popular but now uncommon form of health care delivery, are on the rise. Few studies have focused on the value the experience brings to resident physicians and their patients.

Methods: A 6-month pilot was conducted with 11 residents who participated in 32 home visits with 11 patients. Patient and resident experiences were captured through a survey following the home visits.

Results: In all, 100% of patients and a majority of residents were very interested in being a part of and incorporating future home visits, respectively. Every patient in the survey said that the visits resulted …

Education-Based Interventions Effects On 30-Day Readmission Rates For Patients With Copd, Gina Hand-Eoloff

Dissertations

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing education-based program for Chronic Obstructive Pulmonary Disease (COPD) and its effect on 30-day readmission rates in one hospital in rural Missouri.

Method: A retrospective chart review was completed on 493 patients with an inclusive diagnosis of COPD from June 1, 2018, to March 31, 2019, using a cohort study design and a two-sample t-test analysis. Additional variables were analyzed to determine if there were predictive factors of an elevated risk of readmission.

Results: The two-sample t-test reveals there is no statistically significant difference between the rates of readmission …

Safe Care For Seizure Patients On An Epilepsy Monitoring Unit, Deborah Bachand, Lauri Wilson, Rachel Caiola, Lynne Keller, Megan Selvitelli, Mary Jo Farley, Jennifer O'Neill, Sara Shrock, Hannah Plummer, Sally Prokey, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operations Transformation

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients.

The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified …

The Effect Of Home Blood Pressure Monitoring And Self-Titration On Achieving Blood Pressure Targets, Katina A. Varner

Evidence-Based Practice Project Reports

One-third of U.S. adults over the age of 20 are hypertensive, with an estimated cost of $47.5 billion in direct medical expenses and increased individual CVD risk (CDC, 2018). Routine office visits afford primary care providers a means of managing hypertension; however, time constraints limit the ability to accurately assess and track BP in most patients (Jung, 2015). The purpose of this project was to determine if implementation of HBPM and an algorithm for selftitration of antihypertensive medications increased the number of participants at guideline recommended BP goal over a 90-day period. The Health Promotion Model provided the theoretical framework …

Clinical Practice Guideline Adherence: Primary Prevention Of Cardiovascular Disease In At-Risk Adults, Sharnita L. Rice

Evidence-Based Practice Project Reports

The American College of Cardiology (ACC) and the American Heart Association (AHA) (2013; 2016), as well as the American Diabetes Association (ADA) joined forces to create clinical practice guidelines (CPGs) recommendations for healthcare providers (HCPs) to follow with the aim of preventing cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality in the United States. The Centers for Disease Control (2017a) estimates CVD costs 325 billion dollars annually. Although CVD has an astronomical cost associated with it, CPG adherence continues to be an issue among HCPs and improvement is warranted. The purpose of this EBP project …

Incorporating Oral Health Care In Pediatric Primary Care Practice, Salamatu Yusif

Evidence-Based Practice Project Reports

The most common chronic disease in childhood is dental caries and is more prevalent than asthma and hay fever (HHS, 2000). Data show that in the United States from 2011-2014, 24% of children aged 2-5 years had experienced dental caries in their primary teeth, with 11% having untreated caries (Dye et al., 2017). Primary care clinicians have an important role to play in promoting children’s oral health as much as dentists because they have more contact with children. The purpose of this evidence-based practice project was to integrate an evidence-based oral health program for children in a pediatric primary care …

Implementation Of An Advance Care Planning Protocol To Increase Advance Directive Completion Rates, Christine Engle

Evidence-Based Practice Project Reports

Advanced directives (AD) allow an individual to retain autonomy in end-of-life decisions and can prevent unnecessary costs and treatments associated with aggressive life-prolonging measures. As of 2017, only an estimated 36.7% of the United States adult population had a form of advance directive documented (Yadav et al., 2017). The purpose of this evidence-based project was to determine if implementation of an advanced care planning (ACP) protocol would increase ACP discussions, AD completion, and result in a modification in stage of change or behavior. The Transtheoretical Model (TTM) and Stetler Model of evidence-based practice were used as the framework to guide …

Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean

Evidence-Based Practice Project Reports

Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health …

A Lifestyle Modification Program For Adult Patients With Coronary Artery Disease, Amanda M. Yarbrough

Evidence-Based Practice Project Reports

As a leading cause of death worldwide, coronary artery disease affects people of all races and ethnicities. The foundation for the prevention of secondary fatal cardiac events, such as stroke or myocardial infarction, is lifestyle modification to effectively lower cholesterol levels. Lifestyle change impacts diet, physical activity, smoking habits, vital sign measures, and stress management. The purpose of this evidence-based practice project was to reduce implement a lifestyle intervention to lower LDL-C levels and promote healthier lifestyles. This practice change was developed utilizing Stetler’s Research Utilization model to promote evidence-based practice changes in the clinical setting. Nola Pender’s Health Promotion …

The Effects Of Implementing A Smartphone Application To Improve Asthma Self-Management In Adults, Lindsay J. Humpfer

Evidence-Based Practice Project Reports

Asthma is one of the most common chronic diseases, affecting 20.4 million adults in the United States (CDC, 2018). While asthma can generally be controlled, patients having an exacerbation may experience missed days of work and school, limitations in daily activities, decreased enjoyment of life, and decreased productivity at home, work, and school (MarcanoBelisario et al., 2013). Therefore, the purpose of this project was to improve patients’ overall asthma control and asthma-related quality of life by encouraging self-management through patient education and the implementation of a mobile smartphone application. A total of 26 adult primary care patients with asthma participated …

Effects Of An Obstructive Sleep Apnea Screening Program On Providers' Adherence, Kelsie A. Tokarczyk

Evidence-Based Practice Project Reports

Obstructive sleep apnea (OSA) is a widely prevalent chronic disease estimated to affect 22 million Americans, with 80 percent of moderate to severe cases undiagnosed (American Sleep Apnea Association [ASAA], 2017). Unmanaged OSA has been associated with numerous detrimental health outcomes including hypertension, chronic heart failure, atrial fibrillation, stroke, and other cardiovascular conditions (ASAA, 2017). The purpose of this evidence-based practice project was to determine if the implementation of a screening protocol would affect providers’ adherence to screening for OSA. The Theory of Planned Change was used as a guide to optimize providers’ adherence to the protocol at a family …

Improving Advance Care Planning Documentation In A Home Based Primary Care Program, Emily Radtke

Doctoral Projects

Advance care planning (ACP) is an importance process of reflection and communication regarding one’s preferences for future health care (Hagen et al., 2015). Findings from research indicate that advance care planning supports patient autonomy, improves quality of end-of-life, and increases patient and provider satisfaction (Bischoff at al., 2013; Brinkman-Stoppelenburg et al., 2014). To promote advance care planning discussion, the Centers for Medicare and Medicare Services (2016) made a decision to compensate health care providers for face-to-face conversations regarding future treatment associated with serious illness, offering two new current procedural terminology billing codes for ACP. The Plan-Do-Study-Act model (AHRQ, 2018) was …

Nurse Care Manager Impact On Type 2 Diabetes Mellitus At A Rural Primary Care Practice, Patrick Joswick

Doctoral Projects

Background: Type 2 Diabetes Mellitus is a common diagnosis managed in the primary care setting. Patients with an uncontrolled state of the condition are most vulnerable to develop complications from the disease. Consequently, type 2 diabetes remains as the leading cause of end stage renal disease and nontraumatic limb amputations.

Objectives: To improve type 2 diabetes quality measures, improve documentation of quality measures, increase the continuity of care, and create a streamlined workflow and communication within an interdisciplinary team.

Methods: Quality improvement project to establish multifaceted management of type 2 diabetes. Data on the management of care was gathered pre-/post-implementation …

Implementation Of An Evidence Based Screening Protocol To Improve The Diagnosis Of Dementia In A Home-Based Primary Care Setting, Lauren Liesbeth Sutton

Doctoral Projects

Dementia is a major public health concern that is both debilitating and deleterious to those afflicted with its various forms. The number of those living with dementia is increasing exponentially as the population continues to rise, with 46.8 million people worldwide currently afflicted with dementia (Chow et al., 2018). Dementia causes cognitive impairment that is severe enough to affect everyday function (Chow et al., 2018). The impairment and disability resulting from dementia indicates a significant health problem in primary care. Findings from research studies indicate that prophylactic and periodic screening for dementia can heighten provider suspicion and translate into earlier …

Implementing A Discharge Navigator Reducing 30-Day Readmissions For Heart Failure And Sepsis Populations, Karen Weeks

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

A national focus for healthcare reform is preventing hospital readmissions. Thirty-day unplanned hospital readmissions impact patient outcomes and are costly to the healthcare system. This project explored the impact between the discharge navigator and 30-day unplanned readmissions for heart failure and sepsis populations in a 238-bed community hospital located in central Virginia. The primary aim of this discharge navigator project was to reduce 30-day readmissions for the heart failure and sepsis populations to meet the goals of the top quartile for like hospitals and the evaluation of cost avoidance for these readmissions. Heart failure and sepsis populations are high risks …

Kangaroo Mother Care And Traditional Care, Arianna Smola, Kirsten Lawson

Williams Honors College, Honors Research Projects

Prematurity and low birth weight are leading causes of infant death. Throughout recent years care methods for this population have evolved from incubator care to Kangaroo Mother Care (KMC). The purpose of this systematic review was to answer the following PICO question: in the case of preterm and low birth weight (LBW) infants, how does the technique of Kangaroo Mother Care (KMC) compare to traditional incubator use, regarding long and short-term outcomes of preterm and LBW infant recovery. Methods of this study included the selection of twenty peer-reviewed articles that studied the effect of incubators and KMC on premature and …

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 …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Dose-Response Of Cotton Dust Exposure With Lung Function Among Textile Workers: Multitex Study In Karachi, Pakistan, Naureen Akber Ali, Asaad Ahmed Nafees, Zafar Fatmi, Iqbal Azam Syed

School of Nursing & Midwifery

Background: Cotton dust exposure among textile mill workers lead to impaired lung function. However, only few studies have investigated the dose-response relationship between cotton dust and lung function.
Objective: To determine the dose-response relationship between cotton dust exposure and lung function among textile workers.
Methods: This cross-sectional survey was conducted from January to March 2016 and included 303 adult male textile workers from spinning and weaving sections of 5 mills in Karachi, Pakistan. We collected data through a translated version of the American Thoracic Society respiratory questionnaire (ATS-DLD-78A) and using spirometry. Mill-level airborne cotton dust was measured …

Screening Amblyopic Risk Factors In A Pediatric Population Using An Automated Vision Screener, Rebecca Dawn Slominski

Evidence-Based Practice Project Reports

Amblyopia is the most common visual disorder in children and is potentially curable if detected early and treated properly in the first few years of life. Amblyopia is the leading cause of monocular vision loss in children (Bradfield, 2013). It is a developmental neuroplasticity which derives from birth causing structural and functional changes in the eye and brain. With this structural and functional disruption, visual blur occurs due to refractive amblyopia, strabismic amblyopia, cataracts (form-deprivation amblyopia), or a combination of any of these (Solebo, Cumberland, & Rahi, 2015). Refractive errors related to amblyopia can also occur. The purpose of this …

The Effect Of Algorithm Implementation In The Family Practice Setting On The Pain And Recovery Of Acute Low Back Pain Patients, Joan Caito

Evidence-Based Practice Project Reports

Nearly $86 billion is spent annually in healthcare costs for Americans with low back pain (Lee, McAuley, Hübscher, Allen, Kamper, Moseley, 2016). Additionally, the burden on the economy due to loss in productivity incurs approximately $114 billion dollars of lost revenue annually (Lee et. al., 2016). Patients with an acute low back injury inadequately treated may become a chronic issue. Only 50% of patients who experience back pain symptoms for 12 months will return to work (Petit, Fouquet, & Roquelaure, 2015). The purpose of this project will be to implement an evidence-based algorithm to standardize acute low back pain care …

A Multi-Faceted Intervention To Improve Naloxone Co-Prescription Rates Among Primary Care Providers, Jolane S. Conklin

Evidence-Based Practice Project Reports

It is estimated that 91 Americans die every day due to opioid overdoses, with at least half of those overdoses involving an opioid prescription (CDC, 2016d). To address this issue, the U.S. Department of Health and Human Services (USDHHS) has initiated an opioid initiative, and the Centers for Disease Control and Prevention (CDC) has released a clinical guideline, both of which include a focus on increasing use of naloxone. Despite these recommendations, providers often fail to co-prescribe naloxone to patients at increased risk of opioid overdose. The purpose of this evidence-based practice (EBP) project was to evaluate the effect of …

Home-Based Primary Care: Impact On Cost And Patient Satisfaction, Sarah R. Tupper

All Graduate Theses, Dissertations, and Other Capstone Projects

The aging American population means more people will need healthcare than ever before. Many of these people are or will be Medicare beneficiaries who are predicted to be completely or mostly homebound at some point in time. This literature review was conducted to investigate Home-based Primary Care (HBPC) and whether or not this care delivery model has impacts on cost and patient satisfaction when compared to traditional outpatient encounters. A comprehensive and robust search of the literature was conducted using four different healthcare literature databases. Relevant articles were included if the site of care was ambulatory or office-based and if …

The Effect Of A School-Based Health Center On Access To Care In A Rural Community, Macey Cornwell

DNP Projects

BACKGROUND: Lack of access to healthcare is a nationwide issue that affects underserved, minority, and rural populations. School-Based Health Centers (SBHCs) is one way to help increase access to care for students, staff, and family members.

PURPOSE: The purpose of this project was to provide preliminary data on the impact of a SBHC in a rural Kentucky community on access to care and school attendance.

METHODS: A univariate descriptive analysis was conducted to evaluate the perceived impact of the SBHC on access to care and demographic factors. Data was analyzed using Pearson’s Product Moment Correlation, two-sample t-tests, and The Wilcoxon …

Implementing Evidence-Based Opioid Prescription Practices In A Primary Care Setting, Cyril Gaiennie

Doctor of Nursing Practice

The use and misuse of opioid pain medication has reached epidemic proportions in the United States. More than 16,000 people die each year due to the misuse or abuse of prescription opioid medications, which is more than from heroin, cocaine, and benzodiazepines combined. The purpose of this evidence-based practice project is to establish processes enabling a primary care clinic to implement and adhere to the 2016 Centers for Disease Control’s guidelines for opioid prescription practices in the primary care setting. A retrospective chart review conducted prior to implementation of the guidelines demonstrated that four of six of the CDC’s recommendations …

Improving Early Child Developmental Screenings In A Primary Care Setting: A Quality Improvement Project, Marlischa Jackson

Doctor of Nursing Practice

A dramatic growth of physical, motor, cognitive, communication, emotional, and social development will occur during the 3 years of life. Of children ages 3-17 years of age, 13% have some type of developmental or behavioral condition that goes undiagnosed before the age of 10. Children with multiple health and social risk factors, or those with chronic health disorders, are at greater risk to develop early child delays or disabilities. In the U. S., developmental screenings are only completed 21% of the time during well-child visits. Therefore, the purpose of this quality improvement project was to increase the adherence of health …

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

MaineHealth Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …