Semester

Summer

Date of Graduation

2022

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Not Listed

Committee Chair

Ubolrat Piamjariyakul

Committee Co-Chair

Kendra Barker

Committee Member

Kendra Barker

Committee Member

Kesheng Wang

Committee Member

Jessica Workman

Committee Member

Pamela Edens

Abstract

Background: Diabetes mellitus is a chronic disease that affects nearly 34 million Americans. In rural Appalachia, the population is affected disproportionately at a rate of 14% compared to the national average of 10%. Diabetes is a lifelong, chronic condition managed best by a multidisciplinary team-based approach to achieve optimal disease control. Best practices in the care of diabetes support the use of evidenced based care protocols and leveraging technology to decrease the burden of disease. Type 2 diabetes mellitus (T2DM) is the most common type, making it the focal population for evaluation.

Purpose: The purpose of this project was to evaluate the impact of a standardized diabetes mellitus protocol for patients with T2DM at a rural federally qualified health center (FQHC) in rural southern West Virginia. Program evaluation completes the care cycle. This information can inform stakeholders about a protocol’s effectiveness, thus leading to recommendations for change to improve T2DM education and outcomes in healthcare delivery.

Intervention and Methods: Program Evaluation was completed using a retrospective chart review and a provider survey. Objective 1 was to evaluate the diabetes protocol using seven core quality measures (hemoglobin A1c, blood pressure, low density lipoprotein [LDL] cholesterol, diabetes self-management education (DSME), annual urine microalbumin, retinopathy, and neuropathy exams) over three years (pre-protocol T1 and post-protocol T2 and T3). Objective 2 utilized a provider survey to determine behaviors regarding Type 2 Diabetes Mellitus (T2DM) protocol and diabetes education team awareness and utilization.

Results: Results for Objective 1 found statistically significant improvement at T3 for diastolic blood pressure and annual microalbumin, but not for other metrics. Overall, most metrics noted improvement or stabilization over all time periods despite the evaluation taking place during the COVID-19 pandemic. Results for Objective 2 found that majority of providers were aware of the T2DM protocol and utilized the diabetes education accreditation program (DEAP) team regularly.

Conclusion: The evaluation provided valuable insight on the current efforts to reduce the burden of diabetes mellitus at the facility in rural West Virginia. Over half of all core quality measures met facility benchmarks, however measures for DSME referral, A1c, retinopathy and neuropathy exams are still lower than expected. All providers agree that COVID-19 had a negative impact on patient care. Recommendations for improvements in practice include a patient-individualized approach to care with increasing utilization of the DEAP team, and continuous provider support of DSME in the management of patients with T2DM.

Download

Share

COinS