Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-9-2020

Graduate Advisor

Natalie Murphy, PhD, ARNP, FNP-BC

Co-Advisor

Louise C. Miller, PhD, RN

Committee

Natalie Murphy, PhD, ARNP, FNP-BC

Louise C. Miller, PhD, RN

Pamela Talley, MSN, APRN-BC

Abstract

Abstract

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing Diabetes Care Coordination (DCC) program at an urban clinic for clients with no health insurance in the Midwest. Diabetes related indicators of those enrolled in the DCC program and client reported barriers were documented over a 19 month period.

Sample: Clients included were 18 years and older, with no insurance, having the diagnosis of Type 2 diabetes mellitus, and were enrolled in the DCC program within the first six months of the program's initiation.

Methods: A retrospective chart review of 24 clients recording diabetes related outcome indicators and client reported barriers to care was performed from January 2020 to March 2020 covering the 19- month time period.

Results: There was a statistically significant association between being enrolled in the DCC program and HgA1c outcomes using an alpha value of 0.05, t(23)=2.15, p=.042. There were no statistically significant associations between being in the DCC program and body mass index (BMI), total cholesterol, and LDL outcomes. All 24 clients reported barriers during their enrollment in the program, with 'unable to take medications' being the most prevalent reported barrier (n=49, 35%).

Implications: Results suggest that the DCC management strategy is effective in lowering HgA1c for this at-risk, underserved population needing diabetes care. Providing increased support to improve medication adherence and adding regular consults with a dietitian may improve overall health outcomes, including BMI, total cholesterol, LDL, and blood pressure.

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