Use of Point of Care Testing to Affect Clinician Treatment Decisions for Patients with Diabetes

22.00
Hdl Handle:
http://hdl.handle.net/10755/623561
Category:
Full-text
Format:
Text-based Document
Type:
DNP Capstone Project
Level of Evidence:
Qualitative Study, Other
Research Approach:
Pilot/Exploratory Study
Title:
Use of Point of Care Testing to Affect Clinician Treatment Decisions for Patients with Diabetes
Author(s):
Brow, Shannon I.
Additional Author Information:
Shannon Brow, DNP, RN, CDE, FNP-C - Author may be contacted at: sibrow@flash.net or Shannon Brow, PMB 286, 5773 Woodway, Houston, TX 77057
Advisors:
Schmidt, John; Runewicz, Jo Ann; Black, Jimmy
Degree:
DNP
Degree Year:
2017
Grantor:
Capella University
Abstract:
This process improvement initiative implemented a policy for medical assistants (MAs) to perform and record point of care (POC) glucose test results in the electronic medical record (EMR), for all patients with diabetes during clinic check-in. Actions and behaviors of practice staff were evaluated to determine how POC results affected clinician treatment decisions. A retrospective review of staff recorded (EMR) data was assessed at baseline, after a 2-week run-in, and 4-weeks prospectively. This initiative was implemented in a small group internal medicine practice, treating predominantly low-income, Hispanic immigrant patients in Texas. Staff include six medical assistants, three physicians, and two nurse practitioners. Primary outcomes assessed include MA adherence to the policy and clinician treatment decisions from EMR documentation. Diabetes prevalence was 54.2% in this practice. Medical assistant POC glucose tests were documented for 26.6% (103/387) of patients at baseline and 52% (178/342) of patients after policy implementation. Detailed clinical decision data collection was performed for every tenth record, the evaluated sample n = 34 of 342 records. POC glucose levels were recorded for 38.2% (13/34) of the sample. Clinician treatment decisions changed 23.1% (3/13) of the time when POC results were available. The number of POC glucose tests doubled after policy implementation, yet half of patients did not have POC glucose tests performed. Clinician treatment decisions occurred more frequently when POC glucose values were greater than 200 mg/dl at the time of the clinic visit.
Keywords:
point of care testing; glucose; Hispanic; diabetes; clinician treatment decisions
CINAHL Headings:
Point-of-Care Testing; Decision Making, Clinical; Diabetic Patients; Diabetes Mellitus; Diabetes Mellitus--Therapy; Hispanics; Primary Health Care; Blood Glucose--Analysis; Blood Glucose
Note:
This work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
Repository Posting Date:
2017-11-28T19:40:44Z
Date of Publication:
2017-11-28

Full metadata record

DC FieldValue Language
dc.contributor.advisorSchmidt, Johnen
dc.contributor.advisorRunewicz, Jo Annen
dc.contributor.advisorBlack, Jimmyen
dc.contributor.authorBrow, Shannon I.en
dc.date.accessioned2017-11-28T19:40:44Z-
dc.date.available2017-11-28T19:40:44Z-
dc.date.issued2017-11-28-
dc.identifier.urihttp://hdl.handle.net/10755/623561-
dc.description.abstractThis process improvement initiative implemented a policy for medical assistants (MAs) to perform and record point of care (POC) glucose test results in the electronic medical record (EMR), for all patients with diabetes during clinic check-in. Actions and behaviors of practice staff were evaluated to determine how POC results affected clinician treatment decisions. A retrospective review of staff recorded (EMR) data was assessed at baseline, after a 2-week run-in, and 4-weeks prospectively. This initiative was implemented in a small group internal medicine practice, treating predominantly low-income, Hispanic immigrant patients in Texas. Staff include six medical assistants, three physicians, and two nurse practitioners. Primary outcomes assessed include MA adherence to the policy and clinician treatment decisions from EMR documentation. Diabetes prevalence was 54.2% in this practice. Medical assistant POC glucose tests were documented for 26.6% (103/387) of patients at baseline and 52% (178/342) of patients after policy implementation. Detailed clinical decision data collection was performed for every tenth record, the evaluated sample n = 34 of 342 records. POC glucose levels were recorded for 38.2% (13/34) of the sample. Clinician treatment decisions changed 23.1% (3/13) of the time when POC results were available. The number of POC glucose tests doubled after policy implementation, yet half of patients did not have POC glucose tests performed. Clinician treatment decisions occurred more frequently when POC glucose values were greater than 200 mg/dl at the time of the clinic visit.en
dc.formatText-based Documenten
dc.language.isoen_USen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectpoint of care testingen
dc.subjectglucoseen
dc.subjectHispanicen
dc.subjectdiabetesen
dc.subjectclinician treatment decisionsen
dc.titleUse of Point of Care Testing to Affect Clinician Treatment Decisions for Patients with Diabetesen_US
dc.typeDNP Capstone Projecten
thesis.degree.grantorCapella Universityen
thesis.degree.levelDNPen
dc.description.noteThis work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.-
dc.primary-author.detailsShannon Brow, DNP, RN, CDE, FNP-C - Author may be contacted at: sibrow@flash.net or Shannon Brow, PMB 286, 5773 Woodway, Houston, TX 77057en
thesis.degree.year2017en
dc.type.categoryFull-texten
dc.evidence.levelQualitative Study, Otheren
dc.research.approachPilot/Exploratory Studyen
dc.subject.cinahlPoint-of-Care Testingen
dc.subject.cinahlDecision Making, Clinicalen
dc.subject.cinahlDiabetic Patientsen
dc.subject.cinahlDiabetes Mellitusen
dc.subject.cinahlDiabetes Mellitus--Therapyen
dc.subject.cinahlHispanicsen
dc.subject.cinahlPrimary Health Careen
dc.subject.cinahlBlood Glucose--Analysisen
dc.subject.cinahlBlood Glucoseen
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