Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Diane Slager DNP, FNP-BC

Second Advisor

Karen Buritt PhD , ANP-BC

Third Advisor

Jarrad Utter, MD


Health disparities are differences in health that increase the amount of sickness in certain parts of the population, these inequalities in health are directly influenced by social, economic and environmental status (Healthy People 2020, 2008). Individuals living in poverty, violence, or disability have less opportunity for good healthcare and often have higher rates of chronic disease. Rural geographic locations additionally fall under this category (Healthy People 2020, 2008). These disparities can result from decreased exercise, violence in living situations, and unhealthy diet choices or options (CDC, 2018). Research has shown that health disparities increase with a reduction of individual’s income making it harder to maintain good health the poorer an individual is (Zuckerman, Duncan & Parker, 2016). These inconsistencies cause increased healthcare spending and poorer health outcomes (Zuckerman, et al., 2016). Healthcare is expensive and in the United States can force individuals to make decisions between necessary resources or their health. According to Pennza (2018) single person premiums average at $440 per month and for a family it averages at $1,168 per month. To help reduce these health disparities and reduce the healthcare costs acquired by them there has been significant efforts to increase the quality of care given to these populations to better screen for healthcare issues. The research suggests using appropriate tools and processes can assist primary care clinics to overcome these health disparities and provide comprehensive evidence-based care to help reduce the inconsistencies that are seen in impoverished populations (Zuckerman et al., 2016). This primary care clinic lacks processes to help improve quality measures and providers and their staff are growing increasingly frustrated with the current lack of a process to help them provide quality care. Education, (Breaux-Shropshire et al., 2017; Mader et al., 2016; Reynolds et al., 2018) protocols and implementation tools were implemented within the primary care clinic to improve quality measures. Bundles of care show improved quality measures (Breaux-Shropshire et al., 2017). This clinic implemented a simple three step chart preparation process that gave providers tools toward providing more comprehensive care for their patients with chronic disease. The results showed 97% appropriate therapy implementation with work to be done for the clinic to more fully implement the process.