Doctor of Nursing Practice (DNP) Final Projects

There is an increased risk of misdiagnosis of Attention Deficit Hyperactivity Disorder (ADHD)
in preschoolers due to the lack of validated diagnostic tools and provider knowledge of normal behavior and development. The goal of this project was to standardize the diagnostic process by adopting an evidence-based ADHD algorithm protocol for preschoolers (3-5 years). In an urban military pediatric clinic, five pediatric care clinicians were provided with an educational ADHD algorithm.

Pre/posttest surveys were used to assess provider knowledge and perceptions of care. Chart audits determined preschooler ADHD diagnosis prevalence pre- and post-implementation of the algorithm. The rate of ADHD diagnosis in preschoolers reduced significantly from 78.6% pre-audit to 22.6% post-audit. In addition, providers improved their accuracy in diagnosing alternative disorders and behaviors that mimic the symptomology of ADHD (Z=-2.0, p=0.046). The rate of misdiagnosis of ADHD in preschoolers decreased because of the use of an evidence-based ADHD algorithm.

The reactionary nature of the current healthcare delivery system in the United States has led to increased healthcare spending from acute exacerbations of chronic disease and unnecessary hospitalizations. Those who suffer from chronic diseases are particularly at risk. The dynamics of health care must include grappling with the complexities of where and how people live and attempt to manage their health and disease. Team-based care may offer a solution due to its interdisciplinary focus on proactive, preventative care delivered in outpatient primary care.

Studies examining the effects of team-based care have shown improvement in; HbA1c, blood pressure, lipids, healthcare team morale, patient satisfaction rates, quality of care, and patient empowerment. In an effort to improve type 2 diabetes health outcomes and patient satisfaction a team based care project was implemented. The setting was an outpatient primary care clinic where the patients are known to have limited social resources. The healthcare team was comprised of a DNP Student, Master of Social Work Student, Clinical Pharmacist, and Primary Care Physician, who discussed patient specifics during informal meetings and referral processes.

Adult patients whose HbA1c level was greater than 6.5% were eligible to participate, 183 were identified and invited. Fourteen (14) agreed to participate and seven (7) completed the initial screening with a mean HbA1c of 9.7%. Significant social needs were identified using the Health Leads Questionnaire. The diabetes and social needs were addressed by members of the team who met individually with patients monthly over the course of three months. Of those who completed the initial evaluation only two (2) returned for a follow-up and had a repeat HbA1c. Both participants had important improvements in their A1C with a decrease of 2.3%, and 3.4%. The others were lost to follow up for unknown reasons. Despite the small numbers of participants this project suggests that patients can benefit when an interdisciplinary team addresses their needs and this could improve health outcomes.