Date of Award

8-2017

Degree Name

Nursing (D.N.P.)

Department

College of Nursing

First Advisor

Karyn Butler

Second Advisor

Andrea C. Bostrom

Third Advisor

Rebecca Gebhart

Abstract

Health care spending in the United States far exceeds that of other high-income countries (Squires & Anderson, 2015). In 2013, the U.S. spent 17.1 percent of its gross domestic product (GDP) on healthcare, which was almost 50 percent more than the next highest spender noted as France (Squires & Anderson, 2015). While the U.S. spends more on healthcare than other countries, multiple other health outcome measures are worse including life expectancy, heart disease, diabetes, and chronic respiratory illnesses (Squires & Anderson, 2015). Today’s healthcare system is highly fragmented, lacking the necessary coordination within the primary care setting. Better care coordination may ultimately improve patient care, lower costs, and increase patient satisfaction in health care. In order to address the complex nature of health care there have been multiple models introduced. One model is the Patient-Centered Medical Home (PCMH) with the goal of reforming the healthcare system.

For this scholarly project, a quality improvement project was implemented at an integrated primary care clinic currently PCMH recognized where the PCMH documentation practices of the staff have diminished putting the clinic’s re-recognition at risk. The purpose of this project was to develop a PCMH toolkit to improve the staff knowledge and documentation compliance regarding PCMH. To address the lack of documentation, a toolkit was developed. A survey consisting of 10 Likert-style items was given to all staff members prior to the development of the toolkit to evaluate the level of knowledge about PCMH and associated documentation. A chart audit was conducted to assess the current documentation compliance for PCMH prior to development of the toolkit to guide the focus of the toolkit and educational intervention. The PCMH toolkit was developed to include useful information for staff to utilize during documentation practices based on the results of the initial surveys and chart audit. ThePCMH toolkit also included information for the future PCMH standard requirements and the crosswalk between the current and future standards. Once the toolkit was assembled, the staff were then educated on its contents and how to utilize the toolkit. After a two-week period of time, the staff were given post-intervention questionnaires to assess for changes in knowledge and a post-intervention chart audit was performed to assess documentation compliance. Donabedian model served as a conceptual model to frame the formal quality improvement project exploring staff knowledge and practice about PCMH and required documentation. The Plan-Do-Study-Act model served as an implementation guide for educating staff about PCMH and required documentation as well as developing a PCMH toolkit. Findings suggested that education and training on PCMH and associated required documentation may increase the knowledge of staff members. This may contribute to an increase in successful Patient Centered Medical Home implementation. Limitations of the project included the brief evaluation period and a continued incomplete staffing structure. Recommendations for sustainability and future iterations of the toolkit involve further investigation of the documentation process and identification of effective staffing roles and responsibilities once the staff is up to full capacity with a nursing supervisor in place. The formalization of the quality improvement project in the integrated primary care clinic during the PDSA cycle provided a strong foundation from which to build subsequent PDSA cycles focusing on improved documentation practices.

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