Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dianne Conrad

Second Advisor

Evelyn Clingerman

Third Advisor

Sheila Gardella


An estimated 25.8 million people in the United States (US) have diabetes (Center for Disease Control and Prevention [CDC], 2014). The 2010 Patient Protection and Affordable Care Act led to an increased focus on Quality Improvement (QI) programs to reduce healthcare associated expenditures (Patient Protection and Affordable Care Act, 2010). The purpose of this Doctor of Nursing Practice (DNP) project was to address the following clinical question: Can the comprehensive diabetic bundle of quality metrics for type 2 diabetes mellitus (T2DM) patients in a rural Midwestern clinic be improved through (1) the creation of a QI protocol, (2) increased provider and staff education regarding quality metrics, and (3) the optimal use of QI dashboard software? The DNP project utilized the Donabedian model as the conceptual model to explore the phenomenon of interest, improving the quality of diabetes management. The Promoting Action on Research Implementation in Health Services (PARiHS) framework served as the implementation model to guide the design and development of the implementation strategies to support the evidence-based interventions. The interventions designed to answer this clinical question were: (1) the utilization of the Symphony Performance Health (SPH) QI dashboard software to obtain a T2DM QI metrics baseline, (2) development of a diabetic QI protocol regarding electronic health record (EHR) documentation on diabetes management and optimal SPH QI dashboard software utilization, (3) implementation and evaluation of an educational session intervention on T2DM QI metrics, and (4) the utilization of SPH QI dashboard software to obtain the overall changes in T2DM QI metrics. As a result of these interventions, 5 of 12 (41.6%) diabetic quality metrics were improved with significance (p= 0.05). After the implementation of this DNP project, 4 out of 12 diabetic quality metrics have met the National Committee for Quality Assurance (NCQA) QI metric benchmark percentiles. Prior to this DNP project, only one of the T2DM QI metrics met the NCQA diabetic QI metric benchmark percentiles. This improvement in quality indicator metrics demonstrated the effectiveness of a continuous multicomponent QI initiative to impact care in a rural primary care practice.