Date Approved


Graduate Degree Type


Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing

First Advisor

Cynthia P. Coviak

Second Advisor

Karen Burritt

Third Advisor

Ellen Heit

Fourth Advisor

Guenter Tusch


The purpose of this practice dissertation was to improve the quality of care and outcomes for patients in a small, rural health clinic with a diagnosis of migraine headache. The Institute for Clinical Systems Improvement (ICSI) prepared a health care guideline for the diagnosis and treatment of headaches (Beithon et al., 2013). As part of this guideline, aims and measures were provided for the purpose of quality improvement in migraine headache management (Beithon et al., 2013). The guidelines state the purpose of Aim #5 is to, “increase the percentage of patients with migraine headache who have a treatment plan” (Beithon et al., 2013, p.47), which was measured by the overall percentage of patients with treatment plans utilized to manage the diagnosis (Beithon et al., 2013). This quality improvement measure was accomplished through the implementation of a migraine-specific treatment plan (Silberstein, 2000) that is part of the electronic medical record (EMR) for all patients with a migraine diagnosis within the rural health clinic. The patients included in the project had a migraine diagnosis defined by the International Classification of Diseases, 9th Edition (ICD-9) codes 346.0 through 346.93 (Medicode, 1996), and were between the ages of 18 and 65. The goal of this project was to not only make the treatment plan available within the EMR, but also to achieve greater than 80% compliance by the providers in the clinic for the implementation of the individualized treatment plans for each qualified patient. The clinic achieved a 93% implementation rate as 26 out of 29 qualifying patients seen during the 45-day implementation period received a treatment plan during the visit.

Included in

Nursing Commons