Date Approved

4-20-2026

Graduate Degree Type

Dissertation

Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing

First Advisor

Donna Rinker

Second Advisor

Clay Reeves

Academic Year

2025/2026

Abstract

Background: Individuals with a serious mental illness (SMI) are 2 to 3 times more likely to develop type 2 diabetes, yet are less likely to receive routine screening of hemoglobin A1c (HbA1c) testing. The purpose of this quality improvement project is to implement a standardized workflow process to ensure consistent tracking of HbA1cs in adult consumers greater than 18 years of age with SMI receiving services at a rural community mental health (CMH) organization.

Methods: The primary intervention is a workflow process, with focus on the clinical information systems and organizational system. This quality improvement project was guided utilizing the chronic care model. Pre-implementation data included the percentage of adult consumers with an HbA1c lab value in the electronic health record (EHR) collected before the implementation of the workflow. Post-implementation data were collected six weeks after workflow process. The data were then analyzed using descriptive and inferential statistics to compare pre and post implementation tracking rates utilizing Chi-square test of independence for the primary outcome measure.

Results: At pre-implementation 2.9% of consumers had a documented HbA1c lab value from the past 12 months. Post-implementation, 7.0% of consumers had a documented HbA1c lab value from the past 12 months.

Conclusions: Standardized workflow implementation may improve HbA1c monitoring for consumers in a community mental health setting, and therefore target population specific health care disparities for individuals with serious mental illness.

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