Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dianne Slager, DNP, FNP-BC

Second Advisor

Gabriel Williams, MD

Third Advisor

Meridell Gracias, DNP, AGPCNP-BC


The Center for Disease Control and Prevention (CDC, 2017) reports that approximately 30 million people in the United States (US) have diabetes. Approximately 8 million have diabetes retinopathy (DR) (CDC, 2018). DR is the leading cause of vision impairment in type 2 diabetes patients. Left untreated, DR can result in loss of vision and blindness (Hernández, Simó-Servat, Bogdanov, & Simó, 2017). The US spends approximately $500 million dollars annually in the treatment of diabetes-related blindness (CDC, n.d.). Early detection and management of DR through tight glycemic control, aggressive blood pressure and lipid management is essential to preventing complications of the disease (Cunha-Vaz, 2004). Thus, the National Committee for Quality Assurance (NCQA) and the American Diabetes Association (ADA) endorse yearly diabetic retinal exam screening as part of the management of diabetes (NCQA, 2019; ADA, 2016). Failure by providers to properly manage DR results in forfeiting of an enhanced reimbursement (MVP Health Care, 2018). The purpose of this Doctor of Nursing Practice (DNP) project is to implement an intervention to address the question: Can implementation of a retinopathy protocol improve adherence to screening and treatment standards of care for type 2 diabetes patients and improve quality metrics from baseline at a Midwest (Federally Qualified Health Center (FQHC)? The DNP project utilizes the Burke-Litwin model as the conceptual model and explores the phenomenon of interest, improving the annual retinal exam among patients with type 2 diabetes. Donabedian model guided the interventions of this DNP project (Donabedian, 1988). The Plan, Do, Study, Act (PDSA) framework served as the implementation strategy to support the evidence-based interventions (Health Improvement Scotland, 2019). The intervention is designed to address the clinical question related to: (1) the documentation of the completed retinal exam results in the electronic health record (EHR), and (2) implementation and evaluation of an educational sessions intervention on Type 2 diabetes Quality Improvement (QI) metrics for DR. As a result of these interventions, there was 25.83% improvement in dilated retinal screening with significance of p = 0.0064. This improvement in quality indicator metrics demonstrated the effectiveness of a retinopathy protocol in the management of diabetes retinopathy in an FQHC primary care practice.