Murumba Rachel G, Naman Rachel O, Tuohy Christine A, White Patricia A, Wright Wendy
Tan Chingfen Graduate School of Nursing, University of Massachusetts (UMass) Chan Medical School, Worcester, Massachusetts.
Wright & Associates Family Healthcare, Amherst, New Hampshire.
J Am Assoc Nurse Pract. 2024 Dec 12;37(8):462-470. doi: 10.1097/JXX.0000000000001084. eCollection 2025 Aug 1.
This was an ongoing quality-improvement (QI) project that aimed to assess the quality of nurse practitioner (NP)-driven diabetes care based on the 2023 American Diabetes Association (ADA) Standards of Care (SOC) at a NP-owned primary care practice. In addition, a more recent focus was the assessment of and intervention on social determinants of health (SDOH). Nationally, 47.4% of people with diabetes mellitus (DM) have an HbA1C of >7.0%. Adherence to ADA SOC for DM management minimizes the risk of diabetes-associated complications.
At a NP-owned clinic, within one year, the average A1Cs improved in all patients except those with positive SDOH despite receiving similar care. SDOH predicts DM prevalence and severity of progression, yet screening is not consistently performed or documented.
An ongoing retrospective chart review since 2013 has assessed adherence to ADA SOC among adult patients with type 2 DM at an NP-owned practice. Multiple Plan-Do-Study-Act (PDSA) cycles have resulted in new recommendations that have promoted adherence to diabetes metrics and improvement in overall mean A1C.
The current PDSA cycle emphasizes the creation and implementation of evidence-based interventions to assist NPs in addressing social needs at a NP-owned practice.
Recent data collection has included frequency of SDOH screening, identifying social needs, gaps in SDOH documentation, and has found overall higher A1Cs in patients with positive screens.
Project intervention of social workers collaboration with NPs resulted in improvement in addressing social needs in patients with type 2 diabetes mellitus.
这是一个正在进行的质量改进（QI）项目，旨在评估在一家由执业护士（NP）开办的初级保健机构中，基于2023年美国糖尿病协会（ADA）护理标准（SOC）的由执业护士主导的糖尿病护理质量。此外，最近的一个重点是对健康的社会决定因素（SDOH）进行评估和干预。在全国范围内，47.4%的糖尿病（DM）患者糖化血红蛋白（HbA1C）>7.0%。遵循ADA糖尿病管理护理标准可将糖尿病相关并发症的风险降至最低。
在一家由执业护士开办的诊所，在一年内，除了那些存在健康的社会决定因素阳性的患者外，所有患者的平均糖化血红蛋白（A1C）均有所改善，尽管他们接受了类似的护理。健康的社会决定因素可预测糖尿病的患病率和病情进展的严重程度，但筛查并未始终如一地进行或记录。
自2013年以来持续进行的回顾性病历审查，评估了一家由执业护士开办的机构中成年2型糖尿病患者对ADA护理标准的遵循情况。多个计划-实施-研究-改进（PDSA）循环产生了新的建议，这些建议促进了对糖尿病指标的遵循以及总体平均糖化血红蛋白（A1C）的改善。
当前的PDSA循环强调创建和实施基于证据的干预措施，以帮助执业护士在一家由执业护士开办的机构中满足社会需求。
最近的数据收集包括健康的社会决定因素筛查的频率、确定社会需求、健康的社会决定因素记录中的差距，并发现筛查呈阳性的患者总体糖化血红蛋白（A1C）水平较高。
社会工作者与执业护士合作的项目干预导致在解决2型糖尿病患者的社会需求方面取得了改善。
