Date Approved
4-21-2026
Graduate Degree Type
Dissertation
Degree Name
Nursing (D.N.P.)
Degree Program
College of Nursing
First Advisor
Dr. Dianne Conrad, DNP
Second Advisor
Dr. Andrew Deschaine, DNP
Third Advisor
Allison Ford, NP
Academic Year
2025/2026
Abstract
Background:
Adults with limited English proficiency (LEP) experience disparities in diabetes management due to communication barriers, delayed laboratory results, and fragmented follow-up. Point-of-care HbA1c testing and interpreter services independently improve care, but limited evidence evaluates their combined use in rural primary care.
Local Problem:
A rural federally funded primary care clinic serving a growing refugee population identified delays in HbA1c result availability, inconsistent interpreter documentation, and variable After Visit Summary (AVS) delivery non-English-speaking patients’ preferred language.
Methods:
This 12-week pilot quality improvement project implemented point-of-care HbA1c testing within rooming workflow and reinforced interpreter-supported visits. Pre- and post-intervention data were analyzed using descriptive statistics. Process measures included point-of-care utilization, interpreter documentation, and AVS delivery. The outcome measure was provider-level HbA1c < 8%.
Interventions:
Standardized point-of-care testing, reinforced interpreter use, multilingual AVS templates, and audit-feedback cycles guided by the PARiHS framework.
Results:
Point-of-care HbA1c utilization increased from 73.1% to 83.3% (+10.2%). Language-concordant AVS delivery increased from 10% to 66.7% (+56.7%). Interpreter documentation decreased, likely due to variability in documentation practices. HbA1c < 8% performance remained stable.
Conclusion:
Integration of point-of-care HbA1c testing and interpreter-supported visits improvedtimely testing and language-concordant education. Findings support feasibility and scalability, with potential to improve value-based diabetes outcomes with longer follow-up.
Keywords: Diabetes Mellitus; Point-of-Care Testing; Health Equity; Interpreter Services; Primary Care
ScholarWorks Citation
Celovic, Emina, "Primary care nurse practitioners and advanced practice providers caring for culturally and linguistically diverse adult populations in outpatient settings" (2026). Doctoral Dissertations. 76.
https://scholarworks.gvsu.edu/dissertations/76
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