Date Approved


Graduate Degree Type


Degree Name

Nursing (D.N.P.)

Degree Program

Health Professions

First Advisor

Heather Chappell

Second Advisor

Joy Washburn

Academic Year




Diabetes mellitus (DM) significantly impacts the lives of Americans and the healthcare industry. Clinicians and patients utilize significant time, effort, and resources to combat the challenges faced. Homeless patients have additional burdens not experienced by those of housed individuals. A Midwest homeless shelter recognized the ongoing unmet needs for primary care and behavioral health services for their clinic patients. It was postulated that implementing a streamlined referral process to primary care services, enabling patients to be seen same day or next day, would increase utilization of services by this population. To increase the probability of patients presenting for their appointments nurse care management was included in the referral process. Goals of this quality improvement project were to determine if the homeless population had improved blood glucose levels, reduction of Emergency Department (ED) visits, and increased adherence to primary care services and appointments working with care management (CM) to streamline coordination of care (CC). A comprehensive referral plan utilizing CM was implemented at the homeless shelter. Data collection from referrals were intended to be reviewed and determine effectiveness of interventions. The challenges at the homeless shelter and the population precluded assessment for effectiveness. Multiple barriers were discovered throughout this quality improvement (QI) project resulting in low referral numbers and suggests further intervention may need to be necessary to effectively care for this population.

Keywords: Homeless, homelessness, care management, nursing care management, referral process to primary care, diabetes of homeless, homeless diabetes treatment, homeless and nurse care management, case management, homeless and/or homelessness, coordination of care, diabetes, mental or behavioral health, and referral processes.

Available for download on Monday, April 20, 2026