University of Northern Colorado
Type of Resources
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University of Northern Colorado
Diabetes mellitus (DM), a disease with far-reaching cardiovascular and physiological consequences, continues to grow at epidemic proportions despite efforts by the medical community to manage the disease, placing an enormous financial burden on the healthcare system. The Centers for Disease Control and Prevention released a report in 2014 reporting 29.1 million people in the United States have diabetes including 8.1 million undiagnosed cases. Colorado is one of eight states with the most significant increases in DM diagnoses, nearly doubling between 2003 and 2014. An estimated 300,000 adults have diabetes in Colorado and an estimated 110,000 more are undiagnosed (Colorado Department of Public Health and Environment, 2015). In the last three years, the American Diabetes Association (ADA; 2017), the World Health Organization (WHO; 2011b) and the U.S. Preventative Services Task Force (USPSTF; 2017) have released new recommendations on screening and diagnosing DM--all with nearly identical criteria; yet, these recommendations are rarely referenced or utilized. Glycosylated hemoglobin A1c (A1c) and fasting glucose levels are the most widely recognized tests for screening and managing diabetes and are included in the screening recommendations for the three largest organizations. To enhance the quality and consistency of diabetes screening practices in adults in the primary care setting, the purpose of this capstone project was to create a simple yet comprehensive clinical practice guideline utilizing fasting glucose levels and A1c as screening tests to aid providers at Park Avenue Medical Group in Ft. Lupton, Colorado. Two rounds of Delphi surveys were completed by expert provider participants to provide the foundation for the development of a clinical practice guideline in conjunction with current literature supported by the ADA (2017), WHO (2011b), and USPSTF (2017) and a retrospective study conducted as part of this research project. Five providers responded to the first round of surveys and four responded to the second round to elicit over an 80% response rate on the utility, comprehensiveness, and practical use of a diabetes screening guideline and algorithm. The results indicated a strong need for a discrete and comprehensive practice guideline. Data extracted from the retrospective study, literature review, and Delphi surveys were aggregated to develop the clinical practice guideline; through the use of the second Delphi survey, the guideline was refined to accommodate the provider participants’ recommendations. In addition to the creation of a written guideline, an algorithm was designed that offered two clinical pathways depending on age to screen with an informal risk assessment and A1c at different intervals. Additional recommendations outside the scope of this capstone project were included to conduct a second post-implementation retrospective study after an initial pilot period. The Stetler (2001) model was used to translate the research for this project into practice utilizing a clinical practice guideline.
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