First Advisor

Dunemn, Kathleen

Second Advisor

Romero, Michaela C.

Degree Name

Doctor of Nursing Practice

Document Type

Capstone

Date Created

5-2017

Department

College of Natural and Health Sciences, Nursing, Nursing Student Work

Abstract

Diabetes is a national health care concern that costs that health care system approximately $245 billion per year. The prevalence of diagnosed diabetes has increased 157% in Colorado. As a part of the Affordable Care Act, accountable care organizations (ACO) were developed to help manage the chronic care of diabetes. The purpose of ACOs is to improve outcomes and decrease overall costs. Banner Health is a participating ACO and has clinics in six of the Northeast Colorado counties. Three counties in which Banner has clinics have a disproportionately higher incidence of diabetes compared to the rest of the state. As a means to meet ACO standards, Banner has developed a strategic initiative O1.5. Under this strategic initiative, Banner Health clinics will strive to improve the number of diabetic patients with current A1C measurements and glycemic control of an A1C <9%. This quality improvement project was designed to use Delphi method and the Plan-Do-Study-Act cycle to improve documentation of diabetes-specific metrics. Data obtained prior to intervention were used to establish baseline reporting of A1C in Morgan County clinics. Data revealed that in adults 18-75, 78.2% of patients in the clinics were at A1C control of 9% or lower. A RE-AIM assessment was done to identify areas for improvement; the greatest areas of improvement were in EHR utilization and in process flow. A Delphi method study was used to identify practice change guidelines. For this quality improvement project, the Doctor of Nursing Practice student focused on the documentation and specific process flow to improve the number of patients meeting the chronic care of diabetes initiative goals of having an A1C <9% and current diabetes care within the past year.

Keywords

Diabetes, rural health clinic chronic care.

Extent

73 pages

Local Identifiers

BooneCapstone2017

Rights Statement

Copyright is held by the author.

Digital Origin

Born digital

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