Date of Graduation

Winter 12-13-2019

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Family Nurse Practitioner

First Advisor

Brian Budds, RN, MS, JD

Second Advisor

Alexa Curtis, PhD, FNP-BC


Problem: Santa Rosa Community Health (SRCH) is one of the largest federally qualified health centers in Northern California, providing health care to more than 30,000 patients. More than half of the patients receiving care at the SRCH Lombardi site are Latino patients. Patients self-identify as Latino or other ethnicity on the initial health center registration form. SRCH serves 964 patients with diabetes. Due to limited access to appointments and resources, seeing a healthcare provider regularly can be difficult, posing a barrier to diabetes management. Patients with diabetes would greatly benefit from regular appointments with their primary care provider and resource appointments with a nurse, nutritionist, behavioral health specialist, and pharmacist, yet due to insufficient appointment availability, this is not possible.

Context: The project lead planned, implemented, and evaluated this evidence-based, quality-improvement project for the implementation of weekly shared medical appointments for diabetes education for Latino patients at an outpatient clinic of SRCH. The project was implemented from June to September 2019 with final evaluation in September 2019 and data analysis and dissemination of data to occur in December 2019.

Intervention: The intervention consisted of creation, implementation, and evaluation of a shared medical appointment (SMA) project for quality improvement in patient care. The project goal was to improve patients’ diabetes knowledge, hemoglobin A1C, and satisfaction with SMAs.

Measures: Patients completed a pre- and post-intervention diabetes knowledge questionnaire. Hemoglobin A1C levels were evaluated prior to the intervention and three months later. Patients and primary care providers completed satisfaction surveys.

Results: Patients and providers were very satisfied with shared medical appointments for diabetes. Glucose control through hemoglobin A1C and diabetes knowledge did not show significant improvement in three months, consistent with other studies of SMAs and reflective of the need for longer-term interventions intended to educate, change behavior, and improve health.

Conclusion: SMAs allow for more time for patients to acquire the self-management tools and skills needed to manage diabetes. SMAs provide social interaction, improved social support and increased access to appointments. Additionally, SMAs are important models to consider in moving towards team-based care. On this point, and on the long-term efficacy of SMAs for glycemic control and diabetes self-management, additional research is needed.