Date Approved

4-15-2026

Graduate Degree Type

Dissertation

Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing

First Advisor

Dr. Kellie Riley

Second Advisor

Dr. Leda Evans

Academic Year

2025/2026

Abstract

Background: Missed diabetes follow-up contributes to suboptimal glycemic control in primary care. Health record embedded reminder systems may improve continuity of care, but process evaluation is needed to understand real-world implementation (Bugge, 2024; Rathod et al., 2024).

Objective: To evaluate fidelity, workflow processes, and reach of the Cheers automated A1c reminder program among adults with type 2 diabetes in primary care.

Methods: This retrospective process evaluation used EHR data guided by the CDC Program Evaluation Framework (CDC, 2024). Measures included reminder delivery, follow-up completion, fidelity, and contextual factors.

Results: Of 72 eligible patients, 26 met success criteria (36.1%); 92.0% completed an A1c and 88.0% a follow-up visit within 90 days. A1c declined significantly from first to second post-reminder measurement (7.74% to 7.19%; p = 0.049), and no patients remained poorly controlled (≥9.0%).

Conclusions: Cheers demonstrated value by identifying patients with worsening glycemic control and supporting follow-up associated with A1c improvement. The campaign operated without staff awareness or outcome monitoring. Organizational ownership and dashboard integration are recommended.

Implications for Nursing: Findings will inform workflow refinement and support sustainable nursing and interprofessional strategies strengthening chronic disease follow-up.

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