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: Patient Readmission
- All Subjects: Text Messaging
Mental health issues are a growing concern for individuals and the public. When patients do not attend their mental health appointments they place themselves at risk for poor health outcomes including worsening of symptoms, relapse, hospitalization, or danger to self and other behaviors. The breadth, background, and significance of this issue were investigated to determine a clinically relevant PICOT question. These elements of the PICOT question were investigated and high-quality evidence was gathered, analyzed, and synthesized in order to develop recommendations for an evidence-based project to help with no-shows at a non-profit integrated healthcare organization that is experiencing a high incidence of no-shows. The Quality Health Outcomes Model and Ottawa Model of Research Use guide the implementation and monitoring of the project.
A chart review was completed in order to understand the impact of a novel automated reminder system on the no-show rate for all psychiatric appointments for 18 months. Additionally, demographic and appointment information was gathered to identify trends in the data and factors related to appointment status. The no-show rate significantly increased in 2019 with the new reminder system. No-shows occurred significantly more in males, tele-medicine appointments, and hospital discharge appointments. There were significant differences in no-show rates observed between reported races, with different providers, and at different practice locations. This gap analysis has provided insight into further projects and work to be completed in order to decrease no-shows, improve treatment compliance, produce better health outcomes, and increase revenue for this organization.
According to the National Institute on Drug Abuse (NIDA), tobacco, alcohol, and illicit drugs accounted for 820 billion dollars in costs related to crime, lost work productivity, and health care services. Nearly 20 million Americans suffer from substance misuse, but only 3.7 million received treatment. Of those who receive treatment, the risk of relapse is high, ranging from 40-60% within a year of treatment. Improvement in the treatment of substance use disorders (SUD) is necessary to improve the health of our society.
Current literature demonstrates that individualized recovery plans and follow-up care are effective in reducing relapse and readmission. Costs to the individual, institution, and healthcare system can be reduced. This project aimed to decrease the risk for relapse and readmission with recovery plan reviews at 72hrs, and two-weeks, post-discharge. The risk of relapse was measured by the Time-To-Relapse questionnaire and the UCLA loneliness scale. The project took place in a residential treatment facility in Phoenix, Arizona. There were five participants initially; two were lost at the two-week follow-up. Pre and post-test results were compared to measure potential predictability of relapse. The two-tailed paired samples t-test was performed to compare the means of the scores but yielded insignificant results.
All participants maintained sobriety. Qualitative data via interview showed positive results demonstrated by statements from the participants. Recovery plan review with follow-up care is a promising evidence-based practice that can be implemented to help individuals maintain sobriety. Additional research is recommended to examine further the impact on the maintenance of sobriety over time.
Advanced Practice Registered Nurse Led Transitional Care Program in an Accountable Care Organization
Background: Hospital readmissions place a heavy financial burden on patients, families, and health care systems. Readmissions can be reduced or prevented by providing a safe transition through care coordination and enhanced communication. Research demonstrates implementation of APRN led home visits (HV) along with telephonic follow-up are cost effective and can be utilized for reducing readmissions among HF patients.
Methods: A program was designed with an ACO and carried out in a family practice clinic with a group of seven HF patients older than 50 years who were at risk of readmission. Interventions included weekly HV with supplemental telephonic calls by the APRN student along with a physician assistant for 12 weeks. Readmission data was collected. QOL and SCB were measured using “Minnesota Living with Heart Failure Questionnaire” (MLHFQ) and “European Heart Failure Self-Care Behavior Scale” respectively. Data was analyzed using descriptive statistics and the Friedman Test.
Outcomes: There were no hospital readmissions at 30 days and the interventions demonstrated a positive effect on QOL, self-care management and satisfaction (χ2 = 30.35, p=.000). The intervention had a large effect on the outcome variables resulting in an increase in QOL and SCB scores post-intervention (ES= -1.4 and -2 respectively).
Conclusions: TCP designed with an ACO, carried out in a primary care setting has a positive effect on reducing hospital readmissions and improving QOL, SCBs, and patient satisfaction among HF patients. TCPs are not revenue generating at outset due to reimbursement issues, however future considerations of a multidisciplinary team approach with convenient workflow may be explored for long-term feasibility and sustainability.
Funding Source: American Association of Colleges of Nursing and the Centers for Disease Control and Prevention with support of the Academic Partners to Improve Health.
Heart failure (HF) is one of the most common and costly conditions for hospital readmissions in the United States (Conway, 2015). Cardiac rehabilitation (CR) programs are effective in decreasing hospital readmission rates (Koukoui, Desmoulin, Lairy, Bleinc, Boursiquot, Galinier, & Koukoui, 2015). Medicare has established new requirements for qualification into a CR program; thus, patients are at risk for readmission in the six-weeks post discharge. To reduce HF hospital readmissions and to increase enrollment into the HF program, an infrastructure was implemented beginning in January 2016. This quality improvement project employed a patient chart audit reviewing overall hospital readmission rates for HF at a large hospital in Arizona.
A comparison of readmission rates was made between the 6 months prior to, and the 6-months after the expanded utilization of the HF program. An independent-samples t test was calculated comparing the mean score of the readmission rates before and after a HF CR intervention. No significant difference was found (t(358) = .721, p > .05). The mean of the group before the intervention (m =.15, sd = .36) was not significantly different from mean in the intervention group (m = .13, sd = .33). Implications for practice cannot completely be concluded from this project findings. Continued studies focusing on the enrollment, attendance, and completion of the HF CR program could assist in determining the benefits of referring all patients with the diagnosis of HF to the HF CR program.
Hospital readmissions for palliative care patients are costly for patients, families, insurance providers, and palliative care organizations. The evidence shows that integrating virtual visits into palliative care is an innovative way to reduce hospital readmissions, preserve costs, and reduce geographical barriers. The purpose of this article is to evaluate how well transitional care virtual visits reduce future hospital readmissions for palliative care patients when compared to usual care of in-home nurse visits. Palliative care patients from a large palliative company in Arizona, who received a transitional care, post hospital discharge, virtual visit with traditional model care (intervention) were compared to randomly selected traditional model care patients (control).
Data was collected through a retrospective chart review at 30 and 60 days post hospital discharge to evaluate for hospital readmissions and avoided readmissions. The Fishers Exact test was used to compare the results of the two groups to each other. There was no significant difference between the two groups. Virtual visits have an added cost to the agency without decreasing the risk of readmission. Implications for practice are to continue offering transitional care in-home nurse visits. Future research should evaluate if using virtual visits justify the increased costs of use.
The purpose of this project was to evaluate the utilization of a smartphone application for diabetes self-management education (DSME) into a family practice office. Cochrane review of technological options for DSME identified the smartphone as the most effective option. All patients with diabetes presenting in a family practice office for appointments with the clinical pharmacist or the physician were asked if they would participate in the project if they met the inclusion criteria including the diagnosis of diabetes, owning a smart-phone, and over 18 years old. Exclusion criteria were pregnancy, end-stage kidney disease, or use of an insulin pump.
The goal was to enroll at least 10 patients and have them utilize the smartphone application Care4life for education and blood glucose tracking. HbA1c, heart rate, blood pressure, weight, and body mass index were collected at the initiation of the trial in addition to a demographic survey. A survey was obtained at the end of the trial. Ten patients were enrolled in the project; 50% women. One patient discontinued participation after enrollment. Six patients returned their surveys.
The feedback was primarily positive with individuals liking the text messaging reminders and ability to track their matrix (blood pressure, blood glucose, weight, medication adherence, exercise). Continued utilization of the smartphone application within the practice is likely for those patients who enjoy the technology as a reminder. Further opportunities for implementation would be in a hospital setting where patients face a delay post discharge for an appointment with a diabetes educator. Additionally, due to the complexity of the disease this application could be used to educate caregivers.
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.