Doctor of Nursing Practice (DNP) Final Projects
The Doctor of Nursing Practice Final Projects collection contains the completed works of students from the DNP Program at Arizona State University's College of Nursing and Health Innovation. These projects are the culminating product of the curricula and demonstrate clinical scholarship.
Filtering by
- All Subjects: Oral Health
- All Subjects: Patient Portals
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
Pregnancy is a specific time in a woman’s life filled with complex changes in health, including the oral cavity. During this time, dental and perinatal care teams can be influential in helping women initiate and maintain essential habits to improve health and prevent adverse outcomes. There is research evidence that dental providers are reluctant to treat dental problems during pregnancy. Barriers to practice identified by dentists include lack of education, time, financial constraints, and concern for the safety treating pregnant women. Factors that facilitate dental care for pregnant women include purposeful assessment, referrals from prenatal providers, and continuing education for dental team members.
Multiple organizations recommend the treatment of oral health conditions during pregnancy to promote health and prevent pregnancy complications. In order to promote community-based partnerships in a healthcare system, dentists are encouraged to develop an intentional plan to increase collaboration with other members of the women’s healthcare team. Prior to developing a system wide intervention to improve access to dental care during pregnancy, dental team members were surveyed to identify barriers and facilitators which promote or hinder care in their practice. The data acquired will be used to inform the design and implementation of an intervention to specifically meet the needs of patients and providers in that system.
Pediatric oral health disparities are one of the leading global chronic problems that affect children of all socioeconomic backgrounds. Poor oral health leads to the development of dental caries, which can cascade into an innumerable number of comorbidities, including pain, infection, malnutrition, and decreased self-esteem. Oral health education from the medical and dental home in conjunction with regular cleanings and biannual fluoride varnish has been shown to decrease the risk of caries by at least one third.
Implications for Health Care Providers
Oral health, dental caries, and the resulting comorbid conditions affect the overall health of the child who follows up with their primary care provider. Pediatric health care providers can play a major role in the prevention of these dental caries through the promotion of oral health education and fluoride varnish application during well-child visits
Results
In comparison to pre-data, providers felt more confident and comfortable discussing oral health hygiene and offering fluoride varnish after the educational intervention. There was no significant change in the fluoride varnish applications pre and post in the chart audit; however, there was inconsistent data between the chart audit and the fluoride varnish questionnaire data filled out by providers during the well visit. Lastly, a significant number of parents declined the application of fluoride varnish implying that further intervention should be focused on parent education.
Purpose: The purpose of this project was to assess provider readiness for patient portals and provide an educational intervention to address perceived barriers.
Method: Ten providers at a large family practice clinic in the southwest United States were surveyed using The Provider Readiness Questionnaire prior to and after an educational intervention addressing common concerns.
Results: Improved response to patient portal use after the provider viewed the learning module. A paired-samples t-test was conducted to compare pre-and post-intervention responses. There was a statistically significant difference in the scores for the question “increase my workload” Pretest (M= 3.78, SD=1.201) and; Posttest (M=2.67, SD=1.225) ;(t (8) =5.547, p = .001). There was also a statistically significant difference for the question “increased provider professional satisfaction” Pretest (M=3.89, SD= .333) and Posttest (M= 4.44, SD=.527); t (8) = -2.294, p=.051).
Implications: Providing education addressing perceived barriers to portal use can assist the provider in understanding the value of the portals to improve patient outcomes and address common concerns about the impact of portal use on provider productivity.
Maintaining good oral health during pregnancy is a significant contributor to healthy pregnancy outcomes. The physiological changes that happen during pregnancy can adversely affect women’s oral health and place her at risk for pregnancy outcomes such as miscarriage and preeclampsia. The unborn child’s health can also be affected by premature birth and low birth weight. Although professional organizations have evidence-based practice guidelines for both prenatal and dental providers, the evidence shows a gap between recommendations and practice. An oral health promotion project for pregnant women was implemented in a federally qualified community health center where there was a lack of adherence to the guidelines.
The purpose of this project was to implement established oral health screening guidelines for pregnant women and to increase dental visits among pregnant women. For this project, a two-item maternal oral health-screening tool (MOS) for the prenatal providers was added into the electronic health record to standardize and document oral health screening for pregnant women at their first prenatal visit. After three months of implementation, there was a significant increase in maternal oral health screening and referral. This project may be replicated at any prenatal setting to improve oral health during pregnancy.
Methods: This project was guided by a The Rosswurm and Larrabee Model for Change to Evidence- Based Practice and Pender’s health promotion framework. IRB Approved by ASU. The instruction was implemented at an urban clinic in downtown phoenix that serves uninsured and underserved individuals. Uninsured participants were recruited (n=50). A survey pre and post registration was conducted to assess knowledge and medical portal participation in addition a random pre and post chart review was performed.
Results: Descriptive statistics was used to describe sample and outcome variables. A chi-square test of independence was calculated comparing pre and post intervention significant change was found (χ2 (1) = .002, P<0.05.), a paired sample t test was calculated to compare knowledge pre and post registration instruction the mean pre-10.187(SD = 4.422), post mean was 16.958(SD=.856). A significant increase of knowledge was found (t (47) =-9.573, p (<.001).
Outcomes: In this population both patients and providers have seen significant benefits such as increased communication and patient participation, from the implementation of evidence based educational tools such as instruction with teach back, and the usage of brochures. Potential Implication for sustainability includes the lack of a designated individual that is bilingual to register patients, making patients aware of the existence of a medical patient portal, patient’s fear of sharing immigration status.
Oral health in the pediatric population is an overlooked topic in primary care, yet it is vital to their overall health. Dental caries, otherwise known as cavities, are a significant problem among the pediatric population. Dental caries is the most common non-transmittable disease across the globe. Dental caries can have painful effects that can lead to serious health implications and reduce the quality of life. Prevention is key when addressing dental caries and oral health care. Oral health prevention and education should begin early on in life and continue throughout the lifetime.
Pediatricians and primary care practitioners play a vital role in the prevention identification, and treatment of dental caries. Individuals in these care roles must become familiar with dental caries and the best evidence-based practices. Furthermore, these health care providers can have an active role in policy creation and change within the community to address the issue. A project was conducted to help improve oral health in the pediatric population. The project consisted of a well-child template modification at the 9-month well-child visit that would prompt providers to encourage a dental visit by the 12-month appointment. The results were limited, and the outcomes were not statistically significant. A recommendation for future studies will be to verbalize the recommendation and provide a handout or recommend a specific pediatric dentist.
Background: Influenza presents burdens for children with chronic respiratory conditions including increased mortality, morbidity, hospitalizations, and decreased quality of life for children and caregivers. Influenza vaccinations may reduce these complications yet approximately half of children remain unprotected annually. Synthesized evidence supports integration of text messaging into a multi-component strategy to increase the influenza vaccination rate in many populations of interest.
Methods: The intervention was a single text message and electronic mail message sent to all families in a private pediatric pulmonology practice who enabled text and/or electronic mail messages in the patient portal. A follow-up survey assessed various aspects of message receipt. Surveys were completed without collection of demographic information.
Results: Electronic mail messages were sent to 3140 addresses available in the patient portal. The number of text messages sent out via the patient portal was 75 with 66 (88%) delivered successfully. Follow-up surveys were initiated by 107 recipients. Frequency analysis showed that participants preferred text and electronic mail messages over other forms of communication. A statistically significant positive relationship was found utilizing Chi Square between those who received a message and those whose child received an influenza vaccination (p= .027).
Conclusions: Text and electronic mail messaging are cost-effective and well-received forms of communication that can be easily integrated into existing systems. These delivery routes are translatable to many populations and can convey various types of messages.