LAIR: Lenoir-Rhyne Academic Institutional Repository
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198 research outputs found
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ASCVD Screening for Adults at Risk for Stroke: Primary Care Integration
Get PDFBackground: Strokes impact patients both mentally and physically, yet some patients are unaware of their risk factors and severity of their medical conditions. As the number of patients who suffer from a stroke continues to rise, more emphasis needs to be placed on what can be done from a primary care setting. The purpose of this project is to determine if the implementation of the Atherosclerotic Cardiovascular Disease (ASCVD) risk screening tool initiated by the primary care provider will improve the education and interventions provided to patients at risk for suffering from a stroke. Method: Conducted over a three-month time frame, data was collected through a random sample of 40 patients, aged 40-79, with at least one stroke risk factor present and who were not taking a statin. Patients identified by the primary care provider using the ASCVD risk screening tool were given an educational booklet and treated based on recommendations. A three-month pre-intervention retrospective chart review was used to compare pre-and post-intervention data for patients who met the project criteria. Results: For patients identified at risk for stroke, the mean 10-year and lifetime risk scores were calculated with the lifetime risk being much higher at 37%. Based on screening recommendations, statin therapy was initiated for 37.5% of patients. Linguistically appropriate printed education was provided for 87.5% compared to no printed education prior to the quality improvement project. Conclusion: Implementation of the ASCVD screening tool facilitated identification of patients at risk for stroke and led to improvements in care through focused education and appropriate evidence-based interventions
Caldwell County 2022 Community Health Assessment
No full textThe Community Health Assessment, also known as the CHA, is a North Carolina
requirement of local county health departments. The CHA is implemented every four years by
local health departments to identify, collect, analyze, and disseminate information about the
community’s most pressing health problems to better improve the overall health and quality of
life in the county. In 2022, Caldwell County began the process of their Community Health
Assessment in collaboration with the Community Health Assessment Advisory Committee and
various organizations in the county to start the collection of primary and secondary data. All primary and secondary data collected, discussed, and presented will allow for the progression of program implementation to address the top health priorities and evaluate current community resources to further improve the health of community members in Caldwell County. The assessment will undergo a reviewal process and will be submitted to the state and presented to the county commissioners in the spring of 2023
Atherosclerotic Cardiovascular Disease Screening in the Primary Care Setting
Get PDFProblem: Cardiovascular disease (CVD) and associated atherosclerosis cardiovascular disease (ASCVD) is the leading cause of death for all people residing in the United States. Early detection of CVD through formal screenings during primary care visits is lacking despite being one the best ways to decrease associated mortality and morbidity. The purpose of this quality-improvement (QI) project was to implement an evidence-based ASCVD screening tool in a primary care office, to improve use of an ASCVD screening tool to ensure detection and treatment of ASCVD.
Methods: A quantitative design method utilizing a retrospective chart review to evaluate changes in provider documentation of ASCVD screenings and the patient’s associated risk scores. A statistical analysis using the Chi-square test was conducted to examine the potential influence of the atherosclerotic cardiovascular disease (ASCVD) tool outcomes on healthcare providers’ treatment plans and patient education.
Results: Providers completed ASCVD screenings and documented risk scores on patients who met criteria in 100% of cases after implementation and in 0% of the cases prior to implementation. A Chi-square analysis revealed significant relationships between the patient’s risk category and tool usefulness based on a p <0.001. Furthermore, the results revealed statistically significant associations between the usefulness of the ASCVD tool and the extent of patient education provided by healthcare providers, with a p-value of less than 0.001.
Conclusion: The ASCVD program increased the provider’s screening and documentation of ASCVD risk. This allows the providers to develop an individualized, data-driven, evidence-based care plan for patients at risk for ASCVD events
Improving the Identification of Undiagnosed Diabetes in Primary Care
Get PDFBackground: Over 30 million Americans suffer from diabetes, and over 80 million Americans suffer
from prediabetes and is underdiagnosed within the United States. Early identification for diabetes
conditions, such as using a risk assessment tool, can reduce the medical cost for patients and practices.
This serious, debilitating disease can lead to an increased risk of complications (including stroke, heart
disease, kidney failure, foot infection leading to amputation, and even blindness).
Purpose: The purpose of this quality improvement (QI) project was to determine if the implementation
of a diabetic screening tool known as the American Diabetes Risk Test (ADADRT), in the primary care
setting by providers can help providers and patients diagnose diabetes early, and/or prevent it, most
importantly.
Methods: A quantitative design method utilizing a retrospective chart review was conducted on patients
seen at the practice for the three months before the ADADRT implementation and after to evaluate for
both the primary and secondary outcomes of the QI project.
Results: An independent sample t-test was performed to determine whether there was a significance
between the ADADRT score and if patients should have proper further testing if needed. The result of
the two-tailed independent samples t-test was significant based on an alpha value of .05, t(58) =
12.65, p < .001. Another independent sample t-test was performed analyzing if there was a significance
between the ADADRT score and actually administering the tool itself. The result of the twotailed
independent samples t-test was significant based on an alpha value of .05, t(54.48) = -4.38, p < .001
Recommendations and Conclusion: ADADRT is an effective tool for identification of prediabetes and
Type II Diabetes (T2DM) and a valuable resource for providers to incorporate evidence-based treatment
plans to prevent or alter the progression of diabetes
Implementation of the Alabama Parenting Questionnaire to Evaluate for Disruptive Behaviors in Children and Address with Positive Parenting Tips
Get PDFBackground: Disruptive behaviors such as consistent difficulty controlling one’s actions, vindictive, aggression towards other students, faculty, siblings, and or parents, disregard for rules, resentful, spiteful or consistent deliberate annoyance of others are common in childhood. Although disruptive behaviors are common, they should be assessed by clinicians as part of behavioral and developmental milestone screening at routine child checkups. Parents want providers advise on reducing disruptive behaviors but providers may not be as confident in addressing behavioral concerns.
Objective: The goal of this project was to use the implementation of Positive Parenting Strategies based on responses from The Alabama Parenting Questionnaire (APQ) screening tool to empower clinicians who would guide parents in using developmentally-targeted strategies to decrease disruptive behaviors in children.
Methods: Research Design: This mixed methods quality improvement study utilized the APQ screening tool to assess parental parenting styles. Participants: Data was collected from October 2022- March 2023. A total of twenty parents and their respective children who scheduled visits with concern for their child’s disruptive behaviors and four health care providers participated in the study. Descriptive statistics were used to define participant demographics and APQ scores. Kruskal-Wallis rank sum tests were ran to show statistical significance of behaviors between APQ scores, gender, and medical diagnosis. A qualitative survey was used to assess for provider confidence in utilizing positive parenting strategies and APQ to address disruptive behaviors in children.
Results: The study revealed a diverse range of pediatric patient demographics, with no significant correlations noted between behaviors and APQ scores for gender and diagnosis in the preschool group (.05, χ2(1) - 0.54, p - .464), and (.05, χ2(3) - 6.70, p - .082) respectively. For the school age group, a correlation was observed between behaviors and APQ scores based on gender (.05, χ2(1) - 4.13, p - .042) but not diagnosis (.05, χ2(2) - 2.23, p - .327). Qualitative analysis of open-text responses from providers revealed that the APQ tool was perceived as impractical and time consuming in daily practice, but there was a general appreciation of positive parenting strategies, and a high level of confidence in addressing disruptive behaviors in children.
Conclusion: The project’s primary outcome was successful in empowering clinicians on how to guide parents in using developmentally targeted strategies to decrease disruptive behaviors in children. However, the use of the APQ screening tool did not show improved parental practices or child disruptive behaviors as it was not user friendly and found to be very time-consuming. An alternative screening tool should be considered for future studies and a longer implementation period may be required to properly evaluate the impact of Positive Parenting Techniques on child behaviors
A Primary Care Initiative To Reduce Missed Appointments Among Adult Patients
Get PDFBackground: The benefits of attending a healthcare appointment include reducing the risk of disease and controlling the overall health for patients and the population. A missed patient appointment in the primary care setting can cause a delay in healthcare services and can affect the quality of care.
Objective: To determine if education on the importance of attending a primary care appointment, increased awareness of appointment rescheduling, and electronic reminders will reduce the amount of missed patient appointments.
Methods: This project reviewed the amount of missed patient appointments before and after the implementation of a system change over a five-month period. The project focused on implementing appointment reminders delivered through various communication channels, including phone calls, texts, email, and an educational brochure highlighting what to expect at future appointments and instructions on how to reschedule an appointment. A survey was administered to patients at the post clinic visit to determine how likely they were to attend their next appointment after receiving the intervention.
Results: This project demonstrated a significant reduction in the amount of missed patient appointments, after incorporating multiple methods of appointment reminders and an educational brochure highlighting the importance of attending appointments. The surveys showed that most patients were likely to attend their next appointment following the interventions.
Conclusion: A missed appointment can interfere with adequate medical care, misspend administrative and medical resources, and are associated with adverse patient health outcomes (Davis, 2021). While efforts to address the issue of missed appointments are extensive, solutions have been identified with only limited success (Biggs et.al, 2022). This project revealed a significant difference in the amount of missed patient appointments with the intervention strategies used
Improving Vaping Knowledge Among Teens Through A School-Based Prevention Program
Get PDFBackground: The youth vaping epidemic has been a significant growing public health concern over recent years. Since 2014 teens and young adults have chosen e-cigarettes, also known vaping, as the primary method for inhaling nicotine in the United States (US) (Centers for Disease Control and Prevention [CDC], 2020)
Purpose: The aim of this QI project was to improve teen education about the health risks of vaping utilizing a vaping knowledge survey and curriculum directed at middle-school-age teens ages 10-14 to improve their awareness of the associated risks of vaping.
Methods: A controlled nonrandomized sample of 137 middle school students ages 10-14 who completed a vaping knowledge survey was used. The primary outcome goal was to utilize an easy-to-understand vaping prevention curriculum directed at middle-school-age students to improve their awareness of the associated risks of vaping. The secondary outcome goal was that student's attitudes toward vaping would change, resulting in a decreased likelihood that they would begin vaping.
Results: A Wilcoxon Rank test revealed a statistical increase in knowledge gained by participating in an evidence-based vaping prevention curriculum. These results imply that vaping prevention education positively impacts students' knowledge of the effects of vaping.
Recommendation: It is recommended that the school system continue to utilize the CATCH My Breath program and begin implementation in all eligible schools.
Conclusion: Prevention is vital to controlling the vaping epidemic facing teens and young adults. Educational programs are a valuable prevention tool to address the youth vaping epidemic
Keywords: "vaping," "vaping health risks," "vaping prevention," "vaping education for teens," and "e-cigarette screening tool
Assessing for Suicide Risk in Pediatrics
Get PDFBackground: Due to the increased risk of suicide related to the COVID-19 pandemic, suicide risk should be assessed routinely in the pediatric population using the Ask Suicide-Screening Questions (ASQ) toolkit in a primary care setting to assess suicide risk in children ages 11-18. Early identification and intervention for patients at increased risk of suicide is necessary to improve outcomes in the pediatric population.
Purpose: The purpose of this quality improvement (QI) project is to increase provider use of the ASQ toolkit to provide early identification and treatment of pediatric patients at risk for suicide.
Methods: A quantitative analysis using a retrospective chart review evaluated provider’s use of the ASQ toolkit and provider knowledge and compliance in assessing suicide risk in the pediatric population.
Results: The results of this QI project revealed a 100% increase in provider use of the ASQ toolkit. Appropriate interventions were documented for 100% of the ASQ questionnaires. A Fishers Exact Test was performed to analyze compliance with the ASQ algorithm. The Fishers Exact Test was significant with an alpha value <.05 and p <0.001, which suggests a relationship between two variables, and thus compliance with the ASQ algorithm.
Recommendations and Conclusion: The implementation of the ASQ toolkit increased provider documentation of suicide risk in children ages 11-18. There was a 100% increase in provider use of the ASQ toolkit with proper identification and assessment of suicide risk followed by appropriate interventions provided
Effectiveness of Education on the Use of a Functional Capacity Tool in Corrections
Get PDFackground: There is little to no education provided about how to use an assessment tool used in determining the functional capacity of an incarcerated person in the State Prison system of North Carolina. This assessment, vital to determining the individual needs, is also used to initiate a plan of care, particularly those with chronic or acute illnesses.
Purpose: The aim of this quality improvement project was to develop, implement, and evaluate an educational program designed to assist the medical providers within the state of North Carolina Prison System in the administration of a functional capacity tool known as PULHEAT.
Methods: A quantitative analysis using a retrospective chart review was used to collect pre- and post-intervention data to determine whether a statistical significant change in medical providers’ utilization of the tool occurred. The secondary outcome of the project aspires to provide the highest quality medical care to ensure that each patient seen in the North Carolina State Prison System achieves the maximum functional capacity possible, and that this function, measured objectively, improves over time.
Results: The mean of the scores in the pre-intervention assessment were significantly lower than the mean of the scores in the post-intervention assessment. Thus, fulfilling the primary outcome of this project.
Recommendations and Conclusion: The educational program is expected to be implemented system-wide and made a mandatory annual training. Further research to test the tool is the next logical step, to determine the validity and reliability of the tool itself.
Keywords: correctional healthcare; quality improvement; functional assessment; functional capacity tool; education; patient assessment; medical duty status; patient acuity; correctional medicine; correctional healthcare; correctional nursing; performance improvement
Implementation of a Pressure Ulcer Prevention Training Program in a Rural Nigerian Missionary Teaching Hospital
Get PDFThe purpose of this quality improvement project was to address inadequate knowledge-to-action in Hospital Acquired Press Ulcers (HAPU) prevention with comprehensive HAPU prevention training based on the Agency for Healthcare Research and Quality “Preventing Pressure Ulcers in Hospitals” toolkit at a rural Nigerian missionary hospital. HAPU prevention training significantly improved HAPU prevention knowledge but did not translate to robust performance and documentation of HAPU prevention best practices. Optimizing nurse to patient ratios and HAPU prevention aids can improve adoption of HAPU prevention best practices