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: Quality Improvement
- All Subjects: Social Determinants of Health
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.
Background: Asthma is a chronic illness that impacts 10.9% of the pediatric population in Arizona. Poor asthma understanding and management leads to high-utilization of emergency rooms and urgent care clinics, negatively impacting the healthcare economy. Poor asthma management also leads to decreased health outcomes and impacts on the child’s academic functioning, mental health, and overall quality of life. Current evidence supports use of written asthma action plans (WAAP) and inhaler/spacer instruction to improve asthma management.
Methods: The intervention was an evidence-based educational session provided to the staff of a military, pediatric primary care clinic in southwest Arizona regarding the use of WAAP, the Asthma Control Test (ACT) and integrated inhaler/spacer instruction. Chart reviews were conducted to evaluate the documentation of use of WAAP, ACT, and inhaler/spacer education.
Results: Charts were collected from pre-intervention (n = 33) and post-intervention (n = 18). Data analysis demonstrated a statistically significant higher use of WAAP (U = 0.008, p < 0.05, d = 0.83). Although there was not a statistically significant change in use of ACT tool, Cohen’s value (d = 0.48) suggested a moderate positive effect. A Pearson correlation coefficient was also calculated for the relationship between use of ACT tool and use of WAAP, demonstrating a moderate positive correlation (r (49) = .372, p < .01).
Conclusions: An evidence-based education session for pediatric staff members is a cost-effective and simple method of improving pediatric asthma management practices.
Interprofessional collaboration (IP) is an approach used by healthcare organizations to improve the quality of care. Studies examining effects of IP with patients with type 2 diabetes mellitus (T2DM) have shown improvement in A1C, blood pressure, lipids, self-efficacy and overall greater knowledge of disease process and management. The purpose of this project was to evaluate the impact of IP with attention to identifying and addressing social needs of patients with T2DM. Participants at least 18 years of age with an A1C >6.5% were identified; Spanish speaking patients were included in this project. The intervention included administration of Health Leads questionnaire to assess social needs. Monthly in person or phone meetings were conducted during a 3-month period.
The patient had the option to meet with the doctor of nursing practice (DNP) student as well as other members of the team including the clinical pharmacist and social work intern. Baseline A1C levels were extracted from chart at 1st monthly meeting. Post A1C levels were drawn at the 3 month follow up with their primary care provider. Study outcomes include the difference in A1C goal attainment, mean A1C and patient satisfaction. Pre A1C levels in participants ranged from 7.1% to 9.8% with a mean of 8.3%. Post A1C levels ranged from 6.9% to 8.6% with a mean of 7.7%. Two cases were excluded as they did not respond to the intervention. A paired-samples t test was calculated to compare the mean pre A1C level to the post A1C level. The mean pre A1C level was 8.24 (sd .879), and the post A1C level was 7.69 (sd .631). A significant decrease from pre to post A1C levels was found (t (6) = 2.82, p<.05).
The prevalence of Type 2 Diabetes is on the rise, as are the costs. This nation’s healthcare system must promote interprofessional collaboration and do a better job of addressing SDOH to more effectively engage patients in the management of their disease.
Methods: A multifaceted intervention was utilized that included educational sessions for providers, adjustments to the electronic health record (EHR), access to toolkits, and workflow changes. Pediatric patients aged 5-18 years and diagnosed with asthma (N = 173) were evaluated using a pre-post design. Provider adherence to key components of clinical practice guidelines were assessed prior to implementation, and a three and six months post-implementation. Data was analyzed using descriptive statists and the Friedman’s ANOVA by rank.
Results: Provider education, EHR adjustments, provider toolkits, and changes to office workflow improved provider adherence to key aspects of asthma clinical practice guidelines. A significant difference was found between the pre and post implementation groups (p < .01).
Conclusion: Increased adherence to clinical practice guidelines leads to fewer complications and an overall improved quality of life. Continuing provider education is critical to sustained adherence.