Multidisciplinary Approach to Quality Improvement Intervention to Increase Performance of Comprehensive Diabetic Foot Examinations for American Indians/Native Alaskans

Persistent Link:
http://hdl.handle.net/10150/338892
Title:
Multidisciplinary Approach to Quality Improvement Intervention to Increase Performance of Comprehensive Diabetic Foot Examinations for American Indians/Native Alaskans
Author:
Bennett, Janet S.
Issue Date:
2014
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Background: Low performance rate of comprehensive diabetic foot examinations (CDFEs) causing health care disparity. Objective: Increasing performance of CDFEs at Phoenix Indian Medical Center, an Indian Health Service (IHS) facility. Design: Before-after design, convenience sample. Setting: An IHS adult ambulatory care clinic in urban Phoenix, Arizona. Target: Four primary care providers (PCPs).Interventions: Utilizing the PDSA framework, a multidisciplinary group of clinical staff developed a process to increase the performance rate of CDFEs. Brainstorming, use of the Ishikawa diagram, and root cause analysis led to identification of factors contributing to low rates of CDFEs in the clinic. The QI intervention addressed multiple aspects of activities related to the CDFE performance, including pre-visit planning, enhanced communication, making equipment for CDFEs accessible to healthcare providers, and requesting patients to remove shoes and socks. Measurement: Weekly performance rate of CDFEs. Results: The results, analyzed with a run chart, showed an upward trend in performance for some providers. The median aggregate performance rates for pre and post intervention were 82.6% and 80.2%, respectively. Limitations: This study should be replicated over a longer time frame with more participants. Two significant weaknesses were identified in this study. The required provider de-identification prevented provider feedback. The data collection method provided CDFE performance data based on provider empanelment. This method of data collection reflects composite team care rather than specific provider behaviors. Conclusions: This multidisciplinary approach to improving the performance rates of CDFEs showed an upward trend for some providers but was not statistically significant. Post intervention CDFE performance rates were not improved. Significance: This study highlights the role of the doctorally prepared advanced practice nurse (DNP) in designing, facilitating and evaluating a practice change project to address the rate of provider performance of CDFE for their AI/NA patients. An exemplar, this QI intervention can be replicated for quality improvement initiatives targeting improved healthcare outcomes, crucial to the national effort of addressing healthcare disparities.
Type:
text; Electronic Dissertation
Keywords:
Examinations; Foot; Multidisciplinary; PDSA; Quality Improvement; Diabetic; Nursing
Degree Name:
D.N.P.
Degree Level:
doctoral
Degree Program:
Graduate College; Nursing
Degree Grantor:
University of Arizona
Advisor:
McEwen, Marylyn Morris
Committee Chair:
McEwen, Marylyn Morris

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.titleMultidisciplinary Approach to Quality Improvement Intervention to Increase Performance of Comprehensive Diabetic Foot Examinations for American Indians/Native Alaskansen_US
dc.creatorBennett, Janet S.en_US
dc.contributor.authorBennett, Janet S.en_US
dc.date.issued2014-
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractBackground: Low performance rate of comprehensive diabetic foot examinations (CDFEs) causing health care disparity. Objective: Increasing performance of CDFEs at Phoenix Indian Medical Center, an Indian Health Service (IHS) facility. Design: Before-after design, convenience sample. Setting: An IHS adult ambulatory care clinic in urban Phoenix, Arizona. Target: Four primary care providers (PCPs).Interventions: Utilizing the PDSA framework, a multidisciplinary group of clinical staff developed a process to increase the performance rate of CDFEs. Brainstorming, use of the Ishikawa diagram, and root cause analysis led to identification of factors contributing to low rates of CDFEs in the clinic. The QI intervention addressed multiple aspects of activities related to the CDFE performance, including pre-visit planning, enhanced communication, making equipment for CDFEs accessible to healthcare providers, and requesting patients to remove shoes and socks. Measurement: Weekly performance rate of CDFEs. Results: The results, analyzed with a run chart, showed an upward trend in performance for some providers. The median aggregate performance rates for pre and post intervention were 82.6% and 80.2%, respectively. Limitations: This study should be replicated over a longer time frame with more participants. Two significant weaknesses were identified in this study. The required provider de-identification prevented provider feedback. The data collection method provided CDFE performance data based on provider empanelment. This method of data collection reflects composite team care rather than specific provider behaviors. Conclusions: This multidisciplinary approach to improving the performance rates of CDFEs showed an upward trend for some providers but was not statistically significant. Post intervention CDFE performance rates were not improved. Significance: This study highlights the role of the doctorally prepared advanced practice nurse (DNP) in designing, facilitating and evaluating a practice change project to address the rate of provider performance of CDFE for their AI/NA patients. An exemplar, this QI intervention can be replicated for quality improvement initiatives targeting improved healthcare outcomes, crucial to the national effort of addressing healthcare disparities.en_US
dc.typetexten
dc.typeElectronic Dissertationen
dc.subjectExaminationsen_US
dc.subjectFooten_US
dc.subjectMultidisciplinaryen_US
dc.subjectPDSAen_US
dc.subjectQuality Improvementen_US
dc.subjectDiabeticen_US
dc.subjectNursingen_US
thesis.degree.nameD.N.P.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineNursingen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorMcEwen, Marylyn Morrisen_US
dc.contributor.chairMcEwen, Marylyn Morrisen_US
dc.contributor.committeememberMcEwen, Marylyn Morrisen_US
dc.contributor.committeememberBrewer, Barbara B.en_US
dc.contributor.committeememberDuBois, Janet C.en_US
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