Date Approved


Graduate Degree Type


Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing

First Advisor

Dr. Christina Quick, DNP, APRN, CPNP-ACPC, CHSE

Second Advisor

Dr. Anne McKay DNP, ANP-BC

Third Advisor

Dr. Jason Whateley, DO

Academic Year



Background: The American Diabetes Association (ADA) (2022) identifies comorbidity risk assessments and treatment planning as key health maintenance components for diabetic patients. However, many providers do not adhere to the recommended national guidelines (Brenner et al., 2020).

Objectives: At a rural primary care clinic, the effectiveness of implementing a checklist was evaluated to improve provider adherence to the annual diabetes guidelines set by the ADA.

Methods: A quality improvement project was initiated and guided by the Lean Six Sigma framework. The checklist was implemented to assess if providers adhered to the recommended annual diabetes guidelines. The project evaluated if the checklist was used and the frequency of completion of the individual measures on the checklist.

Results: Provider use of the checklist put each measure’s HEDIS score in the 90th percentile compared with the 50th percentile in the pre-implementation period. Fischer’s exact test was completed to determine statistical significance.

Conclusions: Implementing a diabetes guideline checklist proved feasible to ensure provider adherence. Implementation of the checklist into the EHR should be considered for project sustainability.

Implications: A standardized tool should be utilized to assure provider adherence to the annual diabetes guidelines.