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.
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- All Subjects: Telemedicine
Background and Significance: CRC is the second leading cause of cancer-related deaths in the United States among men and women. Current CRC screening rates remain low, even with advanced screening options available. Meaningful Use sets specific objectives for health care providers to achieve. Documenting CRC screening status and recommending CRC screenings to patients is one of the objectives of Meaningful Use and is considered a Clinical Quality Measure (HealthIT.gov). Factors that lead to CRC screening include primary care providers (PCPs) raising the topic, involving support staff, involving patients in the decision-making process, and setting alerts in electronic health records (EHRs).
Methods: The Health Belief Model and Ottawa Model of Research Use helped guide this project. The project took place at a private primary care practice. The focus was on patients between the ages of 50 and 75 years old meeting criteria for CRC. Five PCPS and five medical assistants (MAs) chose to participate in the study. Participants were given pre and post Practice Culture Assessment (PCA) surveys to measure perceptions of the practice culture. The project included a three-part practice change: PCP and MA education about CRC screening guidelines, EHR documentation and reminders, and a change of patient visit workflow which included having MAs review patient's CRC screening status before they were seen by the PCP and handing out CRC screening brochures when appropriate. PCPs then ordered the appropriate CRC screening, and the MA documented the screening in the EHR under a designated location. CRC Screening Project Evaluation Forms were completed by MAs after each patient visit.
Outcomes: No significant difference from pre to post survey satisfaction scores were found (t (8) = - 1.542, p= = .162). Means of quantitative data were reported from the CRC screening evaluation forms; N=91. The most common method of screening chosen was colonoscopy, 87%. A strong correlation was found (r (-.293) = .01, p<.05) between receiving a CRC brochure and choosing a form of screening. Meaningful Use scores pre and post project are pending.
Conclusion: Patients are more likely to choose a screening method when the topic is raised in a primary care setting. Continued staff education on workflow is important to sustain this change. Further research is needed to evaluate cost effectiveness and sustainability of this practice change.
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.
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.