Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Brandi Temmis

Second Advisor

Dr. Jeanine Maine

Abstract

Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition associated with significant morbidity, particularly among underserved populations. This Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to improve diabetes care among adult patients with poorly controlled T2DM (A1C > 9%) in an outpatient primary care clinic by increasing referrals to the Diabetes Self-Management Education (DSME) program. Guided by the Plan-Do-Study-Act (PDSA) cycle and the OhioHealth Change Management (OHCM) model, the project implemented structured interventions including standardized DSME referral workflows, electronic health record (EHR) prompts, provider education, and culturally tailored communication strategies.

The 12-week initiative targeted 68 eligible patients. By project end, 53% showed A1C reduction and 22% achieved A1C levels below 9%, resulting in a 10% absolute reduction in poorly controlled diabetes. DSME referral rates increased from 9% to 38% (a 322% relative improvement), and 61% of referred patients attended at least one DSME session. Staff confidence in the referral process rose from 54% to 81%, and workflow efficiency improved due to EHR automation. Although financial outcomes were inferred through literature, the intervention demonstrated alignment with value-based care goals and HEDIS performance measures. This project highlights the critical role of nurse-led QI initiatives in closing care gaps, supporting chronic disease management, and advancing health equity through evidence-based practice.

Rights

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