Date of Graduation

Summer 8-17-2015

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Karin Blais RN MSN CNL

Second Advisor

Elena Capella RN DNP

Abstract

The AIM of this CNL project is to identify and connect with, those diabetic patients within the out-patient clinic that are not in compliance with their A1C laboratory values. Contacting these patients to schedule follow up and re-engagement in their health care plan, may improve their overall health care outcomes and decrease their risk of more frequent or prolonged hospitalization and increased use of medications. There are over 25.6 million adult diabetic people living in the United States as of 2010. The total cost of direct and indirect medical care is 174 billion dollars as of 2007. With over 3.9 million in California, the health care costs exceed 24 billion dollars each year. The adult primary care clinic provider panel for this project, is following one hundred and fifty diabetic patients. Upon the first review of the national data-base for this health care center, it was found that the monthly monitoring of these patients had not been consistent. The first month of review found that thirty five of the 150 diabetic patients had not obtained their laboratory testing and were not being followed for their diabetes on a regular basis. The CNL implemented a scheduled time for data-base review followed by initiating contact with those identified as out of compliance. Performing as a systems analyst as well as patient advocate and educator, the CNL offered encouragement and diabetic information to these patients that led to a more consistent follow up and brought them back into contact with their health care team. Each monthly data-base review continued to indicate a positive trend in those patients that were getting their A1C tests completed and scheduling back into the primary care clinic for further evaluation and referrals. The most recent data-base review of A1C laboratory values for this diabetic patient population showed that there were only three patients that had not yet re engaged into this primary care clinic. The results from this project show that with consistent monthly monitoring of the national data-base and maintaining a connection with the patients through monthly contact that reinforces their health care plan, will lead to improved compliance with laboratory A1C testing and may lead to improved health care outcomes overall. This project will be implemented on a broader scale to include all of the primary care providers in this setting as well as adding to the nursing staff monthly goals for improving patient centered care and monitoring outcome data.

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