Doctor of Nursing Practice Project Reports

Permanent URI for this collectionhttps://hdl.handle.net/1969.6/87118

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A quality improvement project to decrease screen use in children aged 0-5 via a parental education program
(2023-12) Ortiz, Pamela Ann
Critical brain development occurs between the ages of zero and five (American Academy of Pediatrics [AAP], 2016). The digitalization of childhood impacts how children experience play, learn, and build relationships (Hutton et al., 2020). The purpose of this QI project was to increase provider use of the “Family Media Plan’” and determine if a parent education would decrease screen-time. This QI project sought to answer the question, will the use of screen-time education, increase provider use of the “Family Media Plan,” increase parent knowledge and decrease screen-time, in children under five years? This QI initiative was reviewed by the Texas A&M University- Corpus Christi Institutional Review Board (IRB) for project/study and approval to proceed was received. The setting for this QI project was a primary care clinic. Participants were a recruited from patients under five, that presented for well visit. Pre-test, post-test design was selected to evaluate efficacy of the intervention. A modified version of the HomeSTEAD survey was selected to measure behavior change. Eight families completed the initial survey and received the educational intervention. A mean of 115.714 minutes was calculated to the question “on average, how much time does the child spend on screened devices per day?” Seven (n-7) families responded to the follow-up telephone interview. A mean of 102.857 minutes was calculated, demonstrating a 12.858-minute decrease and resulting in an 11% decrease from the pre-intervention response. A simple chart review was conducted to identify use of the “Family Media Plan.” Seven of the seven participant EHR had a complete “Family Media Plan.” This study only addressed the amount of time spent with screened media devices and did not differentiate between educational and non- educational programming, nor did it address the varying impact of screen-time versus indoor/outdoor play.
Anticholingeric burden screening and reduction for older adults in long-term care
(2019-08) Arredondo, Derek; Garcia, Theresa; Baldwin, Sara; DeGrande, Heather
Anticholinergic (ACH) medication use amongst older adults has been associated with cognitive decline, development of dementia, counteraction of cholinergic dementia treatments, numerous adverse effects and subsequent prescribing cascades. Older adults in long-term care facilities (LTCF) are exceptionally vulnerable to these adverse effects. This quality improvement project implemented an evidence-based ACH cognitive burden screening and reduction program for adults aged 60 and older (N=31) in a south Texas LTCF to maximize cognitive function. Based on ACH medication screenings, reduction recommendations were made to prescribers for 19 residents. A three-group comparative design was used. The 3 groups included: those without recommended ACH reductions (n=12), those with recommendations for reduction which were approved by their prescribers (n=11) and those with recommendations which were not approved (n=8). Cognitive function was measured with the Short-Blessed Test (SBT) and ACH use with the Anticholinergic Cognitive Burden (ACB) scale. The group with approved reduction recommendations had a decreased mean (M ) ACB score (0.73 points lower, p=0.233) and a lower M SBT score (1.82 points lower, p=0.051) at 60-days post-intervention when compared to pre-intervention. Overall, the 31 participants had a significant decrease in M SBT (by 1.06, p=0.026) and a decrease in M ACB (by 0.23, p=0.422) in the same period. Those without any ACH reduction recommendations (n=12), were found to have a significantly increased M ACB, from 0.42 to 1.08 at the conclusion (p=0.013). The application of an evidence-based ACB screening and reduction program decreased ACB and was associated with clinically improved cognitive function in the residents of this facility. These findings were clinically significant and may also provide useful clinical outcome data to support research into, and improvement of, prescribing practices in LTCFs.
Assessment of the impact of patient/family video visitation on depression severity scores at a hospital-based skilled nursing facility
(2021-08) Robison, April Lynn; Loika, Elizabeth
Background: The COVID-19 global pandemic resulted in regulations severely restricting patient visitation in Skilled Nursing Facilities (SNF). Lack of family visitation can have a negative impact on patients such as loneliness, social isolation, and feelings of depression. Therefore, prompting this facility act to reduce the barriers for this, often fragile, patient population, at high risk for depression. Purpose: The purpose of this quality improvement (QI) project was to improve the resources provided by a hospital based SNF to prevent or lessen depression in patients, related to restricted family visitation, through implementation of a patient family video visitation initiative. Methods: This QI project used a before and after design to implement a technology-based patient/family video visitation initiative aimed at preventing or decreasing depression severity in patients cared for in a hospital-based SNF during the COVID 19 pandemic. Video visitation was implemented using an I-pad and the Microsoft Teams platform to allow for face-to-face visitation. PHQ-9 scores and patient/family satisfaction with video visitation were measured before and after the intervention. Conclusion: The initiation of a technology-based, patient-family visitation resource by the SNF resulted in patients scoring in the minimal depression category before and after the intervention, supporting the use of video visitation to prevent depression or worsening depression due to prolonged isolation of patients. The initiative illuminated the organizational and feasibility factors to be considered and mitigated when introducing new technology and processes into an already strained health care setting. Lessons learned and similar positive outcomes, can be expanded to many health settings faced with long lengths of patient stays where family members have regulatory, organizational, or personal barriers to visitation
A change initiative to prevent critical care nurse burnout implementing a sacred pause following patient death
(2021-08) Volek, Nicole Brion; DeGrande, Heather; Keys, Yolanda
Background: Critical care nurses are increasingly challenged by the complex work environment of the critical care unit. The nature of a critical care nurse’s job can be especially stressful because of the high patient morbidity and mortality, challenging daily work routines, and regular encounters with traumatic and ethical issues. Burnout concerns are particularly important when critical care nurses serve patients who die under their care, which can exacerbate general burnout. Purpose: This evidence-based change initiative aims to prevent burnout and thereby promote resilience in the critical care nurse by using an intentional sacred pause following a patient death. Methods: This change initiative project is a pre-test/post-test design. Burnout was measured pre-and post-intervention (the sacred pause) with the intention to prevent critical care nurse burnout and thereby promote nurse resilience. The Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS-MP) was used to measure nurse burnout. Conclusion: The MBI-HSS-MP inventory scores were similar on both pre-and postintervention assessments indicating prevention of nurse burnout. This evidence-based practice change initiative was well received by the staff members in the hospital and demonstrated clinical significance. Participation in the intervention was documented. The use and progressive implementation of the sacred pause following patient death was naturally implemented by the nurses. Critical care nurses are a vulnerable population susceptible to burnout. Further research around multi-modal health-promoting interventions such as the sacred pause will be beneficial for this population. Supporting critical care nurses to adopt health-promoting behaviors may promote resilience and prevent the risk of burnout that often results in many nurses leaving the profession
A discharge protocol initiative to decrease hospital readmission following amputaton in adults with type 2 diabetes
(2021-08) Vasquez, Jennifer; Zhao, Meng; Park, Gloria; Gobert, Melissa; Watson, Joshua
Introduction: In the United States, lower limb amputations are more common in patients, than in those without diabetes, and can result in infections and unplanned hospital readmissions, that cost the U.S. billions of dollars annually. However, very few hospitals focus on amputation discharge education to prevent such readmissions. The purpose of this quality improvement project is to improve the quality of diabetic amputee discharge education by implementing a Diabetes-Amputation Protocol, with the intent of reducing infection related hospital readmissions. Methods: A Quality Improvement (QI) project conducted in an acute care, nonprofit hospital. A one group, pre-and-post design was used to conduct this project. Inclusion criteria: Participants >21 years of age, with T2DM, with initial amputation received the Diabetes-Amputation Protocol. Paired sample t-tests were used to compare patient knowledge, pre-and-post education. Descriptive statistics were used to calculate monthly percentages of patients who were readmitted and received the protocol. Results: The total number of participants was 30, with a mean age of 59.7 years. Findings from the DWCK questionnaire scores showed a statistically significant positive change from pre-to-post knowledge scores, with t(29) and p <0.01. The readmission rate decreased significantly from 20% to 7%, and 100% of participants received the Diabetes-Amputation Protocol. Conclusion: Improved the discharge material and individualized discharge information based on patient needs can improve patient knowledge, increase independent self-care and reduce hospital readmissions.
Education and reminder initiative to decrease sexually transmitted infections and increase HPV vaccinations in primary care
(2020-08) Pompa, Stacey Crystal; Murphey, Christina; Lee, Kyoung; Martinez, Mario A.; Seidel, Steven
Sexually transmitted infections (STIs) continue to rise within the United States and within local communities. The adolescent and young adult population accounts for nearly half of the new STI prevalence. All STIs are preventable however only 2 have an available vaccine. Since 2006, HPV vaccinations have been available to prevent the incidence of HPV infections and yet the vaccination rates remain low within the United States. An initial chart review of 50 electronic medical records (EMRs) from patients within that age group revealed these patients had no updated HPV vaccination information on their profiles and were not up to date with the completed HPV vaccination series. A quality improvement project was initiated to improve the STD education and HPV prevalence by providing reminders and administering HPV vaccines and educating patients on each visit about STDs at a local clinic within South Texas. A total of 85 patients between the ages of 13-24 years met the criteria to participate in the project, however 33 were excluded due to decline to participant and/or unable to contact for telephone follow up visit, leaving a total of 52 participants (n=52). The study showed an increase of STI education by approximately 87% after implementing verbal and written education during routine visits in primary care. A total of 47 referrals were discussed with the patients in regards to contacting the health department when opens to receive and completion of the HPV vaccination series. Due to the COVID-19 pandemic, patients were also given the health department’s information in efforts for them to contact and follow up with their HPV vaccination administration and completion of series. The number of vaccinations administered and the completed vaccination series among the participants were unable to be obtained due to the inability of administration from COVID-19.
Educational text messaging to improve knowledge and self-care practices among adults with Type 2 Diabetes
(2022-08) Brown, Merlendi; Park, Gloria; Lee, Kyoung; Houlihan, Amy
Poor diabetes knowledge and self-care practices are correlated with impaired glycemic control and vascular complications among patients with type 2 diabetes. Diabetes education interventions are essential to improve diabetes self-management and reduce overall mortality; however, time pressures imposed upon healthcare providers limit the amount and quality of education provided in the primary care setting. The purpose of this project was to determine if an educational text messaging intervention would improve diabetes knowledge and self-care practices among patients with type 2 diabetes in a rural primary care clinic. A pretest-posttest, quasi-experimental design was utilized and twenty patients with type 2 diabetes were recruited for this project. Three distinct educational text messages were disseminated weekly for 12 weeks. Six educational domains were addressed: nutrition, physical activity, foot care, blood sugar management, behavioral support, and general diabetes knowledge. Pre- and post-intervention measures consisted of diabetes knowledge and self-care participation questionnaires. From pretest to posttest, considerable improvements were observed in diabetes knowledge scores (13.3% increase), the number of days per week participants engaged in healthy (general) eating habits (15.7% increase), and the number of days per week participants engaged in foot care practices (21.4% increase). The results of this project indicate that educational text messaging can improve diabetes knowledge, general eating habits, and foot care practices among patients with type 2 diabetes in a rural primary care clinic. Based on these findings, we recommend integrating educational text messaging into clinical practice.
A health policy education initiative to increase political self-efficacy in texas nurse practitioners
(2020-08) Aleman, Kristy; Aleman, Kristy; Garcia, Theresa; Garcia, Theresa
Texas ranks lowest in the nation for access to healthcare. Improvement could be facilitated by active engagement of nurses in political activities and health policy advocacy. Political Self Efficacy (PSE) is the belief or idea that one can influence policymakers and/or the political process. Historically, nurse practitioners (NPs) have had low PSE because political activity in nurses tends to be limited to voting. This health policy education initiative was a collaboration between the Texas Nurse Practitioners (TNP) organization and Texas A&M University-Corpus Christi (TAMU-CC) to provide an evidence-based educational resource for Texas NPs to improve their PSE and ability to advocate for high quality healthcare for Texas residents. Approximately 5,145 members of TNP, were invited to participate in this health policy education initiative. Participants completed the Efficacy Index (EI) survey before and after attending two live educational webinars addressing key NP policies, the legislative process and engagement in advocacy. Participants were predominantly White females, held a master’s degree in Nursing, were certified as Family Nurse Practitioners, aged 46-65 years of age, and had an income between $80,000-$120,000/year. Pre-education mean scores improved, but only slightly (Webinar 1: 48.3 to 50.0; Webinar 2: 49.3 to 50.5). Initial levels of PSE in this NP sample were higher than expected, likely due to higher education, experience, and membership in a professional organization. Targeted educational interventions can improve PSE levels in NPs resulting in increased engagement in the political process, making it imperative to educate all nurses, and to expand educational opportunities to NPs outside of professional organizations. Nurses constitute the largest group of healthcare providers and have the potential to positively impact legislative health policies. Through increased PSE, Texas NPs can become the needed change agents to advocate for the rights of their profession and their patients.
Identifying barriers to diabetic self-management education for adult Hispanic males
(2019-08) Lopez, Hugo; Keys, Yolanda; Garcia, Theresa; Peck, Jessica L
This quality improvement project explores diabetes self-management barriers for adult Hispanic males with type II diabetes mellitus at the Texas A&M Coastal Bend Health Education Center (CBHEC). Since diabetes is one of the leading causes of death for Hispanic persons, especially men with behavioral characteristics associated with machismo, information on barriers preventing adult, Hispanic male attendance at CBHEC would help to improve their program. The director of this quality improvement project administered a Masculine Behavior Scale (MBS) questionnaire, conducted individual interviews, and identified essential elements of the participants’ experience which can be used to improve the CBHEC program. Recommendations were formulated for stakeholders to improve program offerings and encourage attendance of adult Hispanic males with identified barriers and serve as a basis for future projects to improve patient outcomes for the target population.
Identifying migration flexibility and the environmental factors that influence variation in recruitment success in partially migratory Hawaiian fishes
(2019-05) Heim-Ballew, Heidi; Hogan, J. Derek; Portnoy, David; Pollack, Jennifer
Behavior flexibility during the larval stage influences differential mortality, recruitment, and population dynamics; recruitment is poorly understood, yet important for understanding population persistence. The purpose of this dissertation was to examine fishes for migration flexibility and to identify factors at different spatiotemporal scales that are influential to differential survival within and across populations. I found that four underexplored native freshwater fishes of Hawai‘i exhibited a larval migratory strategy, but many were flexible. One species (Sicyopterus stimpsoni) showed all individuals made a migration, and the others showed 25 – 40 % did not migrate. Next, I examined if migrant (S. stimpsoni) and flexible species (Awaous stamineus) showed lunar rhythmicity at hatching and settlement. Migrants of the flexible species showed more hatching around the full moon and settlement around the new moon, and residents showed the opposite pattern. The divergence in life-history timing appears to be a balance between ecological costs and benefits. Next, I examined the influence of variation in localized conditions on the ratio of migrant to resident contingents (A. stamineus) in adult populations. Residents were least represented when stream flow and nutrients were low; however, the abundance of a common invasive predator showed a negative relationship with resident abundance. Highly urbanized systems may impose such stressful conditions that resident recruitment is diminished, which underscores the importance of stream management to conserve vulnerable native species. Lastly, I examined the frequency of contingents (A. stamineus), larval duration, and growth rates across ENSO. The proportion of migrants was highest during La Niña, and resident proportions were highest during weak La Niña and strong El Niño; once El Niño became very strong, resident proportions decreased. Migrants had faster growth than residents across all growing stages. Migrant growth rates in the early larval stage were highest during El Niño, and pre-settlement growth was highest during La Niña. Resident growth was fastest during neutral conditions. The duration of the early fast-growing period was shortest during El Niño, and the larval duration was longer. These dissertation findings show the importance of evaluating multiple influential scales to understand life-history strategies of individuals, especially those that inhabit multiple ecotypes.
Implementation of a discharge pathway to decrease infant's postoperative length of stay in a cardiac intensive care unit
(2022-07-08) Buckner, Brenda Rachelle; Loika, Elizabeth; Lee, Kyoung; Davis,Liana
Congenital heart defects (CHDs) are the most prevalent of all birth defects. In the United States there are about 40,000 new cases diagnosed annually. About 25% of those infants have a critical congenital heart defect (CCHD) requiring surgical intervention in the first 30 days of life in order to survive. Discharge from the hospital to home is a major process that, if fragmented, is inconsistent or unstructured can lead to medication errors, treatment delays, increased health care costs, and lower quality of care. Safely transitioning infants with CCHDs from the hospital to home requires planning that begins on admission. The purpose of this quality improvement project was to determine if implementing a standardized discharge pathway for infants with CCHDs could improve the discharge processes and decrease postoperative length of stay in a 22-bed mixed Pediatric Intensive Care Unit (PICU) and Cardiac Intensive Care Unit (CICU). The pathway was initiated on all infants requiring a surgical intervention within the first 30 days of life. The aim of having 100% of participants with a completed checklist by the end of the three-month project and 100% of parents completing the required rooming in period before discharge were met. However, no decrease in PLOS was demonstrated in this quality improvement cycle for STAT 2 and STAT 3 categories and a 0.5 day decrease in PLOS was demonstrated in STAT 5.
Implementation of obstructive sleep apnea screening tools in hemodialysis centers for patients with end-stage renal disease
(2021-08) Beal, Lisa A.; Keys, Yolanda; Garcia, Theresa; Acker, Katelijne
Background: Chronic Kidney Disease (CKD) is a devastating health crisis affecting approximately 37 million United States adults. Obstructive sleep apnea (OSA) is a commonly, undiagnosed comorbidity among CKD and End-Stage Renal Disease (ESRD) patients. The prevalence of OSA is reported to range from 45%-70% in ESRD patients, which is significantly higher than the general population at 3% -7%. Screening tools such as Epworth Sleepiness Scale (ESS) and the Berlin Questionnaire (BQ) may assist in identifying patients at risk for OSA. Purpose: The purpose of this quality improvement project was to initiate the implementation of OSA screening tools in a north Flordia hemodialysis center to identify patients with ESRD at risk for OSA. Methods: This was a quality improvement project that used a pretest-posttest design to evaluate case managers’ (CM) knowledge of OSA and the implementation of the Epworth Sleepiness Scale (ESS) and the Berlin Questionnaire (BQ) screening tools. A total of 15 CMs attended a brief OSA education session and completed a pre-post OSA knowledge survey prior to screening patients using the ESS and BQ screening tools. Results: The results (t = 11.75, p = 0.001) showed a statistically significant improvement in CM knowledge between the pre-post OSA education scores. The results also found that 47% of patients screened were at high risk for OSA, resulting in 8 patients referred for a sleep study. Implications: Providing education to the CM on OSA and establishing a protocol to screen patients can lead to early sleep study referrals and more timely treatment.
Implementing an antibiotic stewardship program to decrease antibiotic overuse in a primary care clinic
(2021-08) Sigdel, Sabita; Garcia, Theresa; Baldwin, Sara
Background: Antibiotic overuse is one of the largest threats to global health. Nearly 50% of antibiotics prescribed in outpatient settings are unnecessary. The overuse of antibiotics is associated with antibiotic resistance, unnecessary adverse drug effects, and increased healthcare costs. Purpose: This quality improvement (QI) project aimed to increase patients’ knowledge and improve their attitude toward appropriate antibiotic use in acute respiratory tract infections (ARTIs) and decrease antibiotic over-prescription by providers through the implementation of an antibiotic stewardship program in a North Texas primary care clinic. Methods: This is a before and-after design QI project that implemented Centers for Disease Control and Prevention’s (CDC) antibiotic stewardship educational intervention. A convenience sample (N=20) was recruited from all interested English-speaking patients who were 18 years or above. Patients’ knowledge and attitude towards antibiotic use was assessed before and after an educational intervention. The second part of the project entailed provider education using a training activity from Stanford University (N=2). Pre- and post-training retrospective chart review was done to determine changes in antibiotic prescription rate. Results: There was a significant increase in patients’ knowledge and their attitude towards appropriate antibiotic use in ARTIs (p < .001) after the educational intervention. Secondly, there was a 15% reduction in antibiotic prescription rate in 2021 compared to the same months in 2020. Conclusion: Provider and patient educational interventions are effective strategies in promoting antibiotic stewardship in outpatient settings and improving inappropriate antibiotic use in ARTIs. Further research is needed to explore innovative educational strategies incorporating inexpensive technology.
Improving adolescent psychosocial assessment through standardized patient simulation: An interdisciplinary quality initiative
(2022-08) Eaves, Colleen; Monahan, Laura; Watson, Joshua; Malatyali, Ayse; Walker, Benjamin
Prevention of adolescent suicide is possible with early recognition of risk factors; however, many healthcare professionals lack necessary skills to interact effectively with adolescents due to insufficient training in residency. Supplementing traditional clinical experiences with communication focused education utilizing standardized adolescent patients (SP) has proven promising. This interdisciplinary quality initiative (QI) piloted an SP program informed by the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidality, and Safety (HEEADSSS) interviewing process within the physician and nursing residencies of a South Texas pediatric tertiary care center to improve early identification of modifiable risk factors of suicidality among adolescent patients. Thirty-six residents participated in a program comprised of a 45-minute self-study module and a two-hour SP simulation session incorporating adolescent psychosocial interviews with individualized feedback and guided group reflection. Results of the one-group, pretest-posttest QI were favorable. A 13% increase in self-efficacy (M = 8.64, SD = 0.65), p =<.001, d = -1.79, 11% increase in competence (M = 55.83, SD = 7.58), p =<.001., d = -0.56, 17% increase in HEEADSSS use in practice (M = 2.55, SD = 0.69), p = 0.02, rrb = -1, and 89% increase in social work referrals for adolescents presenting with chief complaints not related to mental health were observed. While these improvements satisfied only one of the project’s aims fully, the clinically significant findings are encouraging and warrant the formal incorporation of the adolescent SP program into residency curriculums along with the exploration of utilizing SP methodology within other QI throughout the organization.
Improving cancer caregiver support through a focused caregiver preparedness program
(2020-08) George, Jincy; Baldwin, Sara; Garcia, Theresa; Thomas, Tincy; Sanders, Jana
Background: It is estimated that there are four million cancer caregivers (CG) in the United States. A majority (69.1%) of them experience various emotional burdens. Cancer CGs face various unmet emotional and psychological needs and are often expected to manage cancer patient symptoms for which they are largely unprepared. Since they are an integral part in cancer patients’ treatment planning and care, it is important to reduce CG emotional burden and improve their self-efficacy. The purpose of this quality initiative is to determine if a structured treatment specific program can reduce emotional burden, improve self-efficacy for patient care demands, and improve CG support group enrollment among CGs of patients receiving brain radiation treatments at CNS-RO clinic at MDACC. Design and methods: CGs were screened and enrolled followed by administration of a pre-intervention assessment of the CG burden and selfefficacy using Zarit Burden Interview and CG Self-Efficacy Scale respectively. During the intervention phase, the project director provided interactive teaching sessions regarding patient symptom management, coping strategies, and CG support group enrollment. After the intervention, each CG received an assessment of CG burden, self-efficacy, and CG group enrollment. Findings: CGs had significant reduction of burden (p = 0.0004), improvement of self-efficacy (p = 0.0152) and improvement in CG support group enrollment. While the sample size is considered small, the clinical results support using a standardized treatment-specific CG preparedness program to ensure best possible care for both the patient and the cancer CG.
Improving child obesity screening and management provider practices in a South Texas pediatric clinic
(2019-08) Pesina-Garcia, Ashley; Garcia, Theresa; Ajisafe, Toyin; Baldwin, Sara; Keys, Yolanda
Childhood obesity is an epidemic in the United States (US) and affects nearly one in five school-aged children. Inconsistent provider practice patterns, which often do not adhere to current clinical practice guidelines, can decrease the quality of childhood obesity screening and management. This quality improvement (QI) project implemented a provider education, reminder, screening and referral program to improve screening and management of overweight and obese children, aged 6-12 years old, attending a South Texas pediatric clinic. A comparative two-group, retrospective chart review and descriptive survey design guided the project. Eleven parents were surveyed and 126 charts (from 3 providers) were reviewed (pre-education: n=71; post-education: n=55). Provider practice post-education and reminder system was significantly improved on the use of overweight and obesity diagnosis codes (χ2 (1, N = 126) = 12.77, p<.001), overweight and obese labs ordered by provider (χ2 (1, N=126) = 9.49, p=.002), overweight and obese healthy behavior counseling (χ2 (1, N=126) = 14.14, p<.001), and follow-up visit recommendation (χ2 (1N=126) = 15.88, p<.001). There was no significant difference between groups in provider referrals to a fitness program. The parental survey indicated a significant improvement in child activity and nutrition behaviors patterns pre-provider education compared to post-provider education (Z=-2.805, p=.005, r=.25). A provider education program improved the screening and management practices of providers for children with overweight and obesity in a small pediatric clinic in South Texas.
Improving Hispanic childhood obesity using an algorithm-based quality initiative in pediatric primary care
(2020-08) Potter, Deborah; Garcia, Theresa; Keys, Yolanda; Platt, Adrienne; Bruun, Faye
Child obesity is increasing and is considered one of the most serious health concerns of the 21st century. Hispanic children represent the largest group of obese children in the U.S. when compared to other ethnic groups. Health care providers (HCPs) have been recognized as key players in the prevention and treatment of child obesity, yet many studies indicate clinical practice guidelines are not always followed. The purpose of this quality initiative was to improve HCP management, and counseling of overweight and obese Hispanic children between the ages of 6-16 years, by providing an educational session and management tools to pediatric providers in a South Texas clinic. HCPs attended a 30-minute educational session, guided by the American Academy of Pediatrics’ algorithm for childhood obesity management; and the 5210 Healthy Habits Questionnaire was used to assist providers with assessment and counseling of patients and parents. Provider practice changes were compared to the same timeframe a year earlier via chart review. The sample of charts reviewed included 193 children, 51% male, 41% overweight or obese in 2019 and 135 children, 41% male, 47% overweight or obese in 2020; at least 96% identified as Latino/Hispanic and mean age was 10.4 years in both groups. Provider documentation of healthy activities assessment improved 17-25%, healthy habit counseling 12- 21.5%, and referrals to dietitian 6%, post-intervention. Results were promising and trending toward positive practice changes, however greater improvement in HCP practices and patient outcomes may have been realized if the timeline of the project had not been interrupted by competing healthcare priorities due to the COVID-19 pandemic. Providing algorithm-based education and resources for primary care providers in a pediatric clinic can improve practice and has the potential to impact outcomes for overweight and obese Hispanic children.
Improving interprofessional collaboration between physicians and nurse practitioners in virtual primary care telehealth through co-management education
(2020-08) Amadi, Rene Habinuchi; Amadi, Rene Habinuchi; Keys, Yolanda; Keys, YolandaKeys, Yolanda
By 2032, it is predicted the United States’ (US) need for primary care physicians will exceed supply by as much as 55,200 physicians. Nurse practitioners (NPs) are prepared and positioned to help fill the primary care provider gap. The co-management model requires interprofessional collaboration between a physician and nurse practitioner who share responsibility in managing a patient’s healthcare needs. Improving providers’ knowledge and attitudes toward interprofessional collaboration has the potential to lessen the primary care provider shortage while improving patient access to care. This quality improvement project was originally focused on improving physicians’ knowledge and attitudes toward NPs and interprofessional collaboration in a virtual, primary care, telehealth clinic. Due to an unexpected pandemic, data collected was modified to include changes in NP caseload and changes in NP expectations, and roles at the project site as a result of COVID-19. The pandemic provided an opportunity to expedite interprofessional collaboration at the project site.
Improving lipid screening and management in pediatric primary care through a provider education and reminder program
(2019-08) Patel, Stephanie Lyne; Peck, Jessica; Garcia, Theresa; Keys, Yolanda
The National Heart Lung and Blood Institute (NHLBI) recommends universal lipid screening (ULS) for 9-11-year-old children. Limited available data suggest less than 50% of primary practice providers are using ULS guidelines (ULSG) appropriately. Insufficient implementation of ULS completion contributes to a failure to identify children aged 9-11 with dyslipidemia and can contribute to early cardiovascular disease. This Quality Improvement (QI) project implemented a provider-focused education intervention and retrospective chart review to increase completion of ULS in children aged 9-11 years old and to improve provider management in a pediatric primary care clinic in Central Texas. A one-group pre-test/post-test design was used. Participants included five physicians, 20 nurse practitioners (NPs), and five physician assistants (PAs). Chart review was conducted on all children aged 9-11 years who presented for well-child checks both three months prior to the intervention (n=911) and three months post-intervention (n=1045). A pre-and post-intervention provider survey was used to measure changes in lipid screening provider knowledge and practices. Providers’ knowledge of and completion of lipid screening increased from 70% to 89%. Utilization of educational sessions increased provider knowledge of ULSG and increased the number of 9-11 year-old children screened for dyslipidemia in this clinic.
Improving provider obesity management for Latino adolescents through a clinic-community program partnership
(2021-08) Sitienei, Esther; Garcia, Theresa; Greene, Pamela
Background: Obesity prevalence in children aged 5-19 dramatically rose from 4% in 1975 to over 18% in 2016. Rising obesity rates are linked to adverse health outcomes such as cardiovascular diseases and diabetes, which disproportionately threaten Latino youth in Texas, where obesity prevalence is higher in Latino children (19%) compared to Caucasian children (10%). Objective: This quality improvement initiative used a clinic-community program partnership and the Pediatric Obesity Algorithm to improve health care providers' obesity management skills, and Latino adolescents’ weight, Body Mass Index (BMI), and healthy behaviors. Method: A before-and-after design was used to facilitate a partnership between a family practice in central Texas and a community outreach program providing a free online coaching exercise program to overweight and obese adolescents referred by their providers. Adolescents screened and diagnosed with overweight, or obesity (n=15) received a 5-2-1-0 Let’s Go! instructional guide, monthly provider visits, pedometer, healthy habits log, and an online access code to the exercise program. Adolescents’ weight, BMI percentile, and self-reported daily health habits log, and providers’ screening and referral rates were collected at baseline and monthly for three months. Results: Post-intervention, adolescents’ weight (p = .003) and BMI (p = .023) decreased and 95% reported improved health habits. Provider obesity screening (100%) and referral (73%) rates also improved. Conclusion: Creating a primary clinic-community resource partnership improved providers’ obesity management, and adolescents’ health habits and significantly decreased weight and BMI for Latino adolescents in this central Texas clinic.

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