Student Name
Capella University
NURS-FPX 6011 Evidence-Based Practice for Patient-Centered Care and Population Health
Prof. Name
Date
Implementing Evidence-Based Practice
Clinical Background
Diabetes Mellitus (DM) represents a critical global health concern, characterized by insulin resistance and a relative deficiency of insulin. Within our healthcare organization, Saint Mary’s Medical Center in Huntington, West Virginia (WV), DM remains a prevalent condition. Poorly managed diabetes contributes to severe complications, including cardiovascular diseases, neuropathy, nephropathy, retinopathy, and an increased susceptibility to infections. Despite existing evidence-based guidelines and various pharmacological and non-pharmacological interventions, effective diabetes management continues to be a challenge in this healthcare setting.
In West Virginia, approximately 227,400 adults—around 15.8% of the adult population—are diagnosed with diabetes, with an estimated 8,500 new cases each year (ADA, 2024). The economic impact is substantial, with direct medical costs reaching about $1.67 billion annually. Contributing factors to suboptimal diabetes management include inadequate patient education, limited access to healthcare services, poor medication adherence, and unhealthy lifestyle choices. Furthermore, healthcare providers face barriers in implementing guideline-based care due to time limitations, competing priorities, and scarce resources (Al-Qerem et al., 2021).
PICOT Question
“In adult patients with DM (P), does telehealth educational session on dietary modifications and behavioral support (I), compared to standard care alone (C), regulate glycemic control (O) over six months (T)?”
This PICOT question seeks to evaluate the effectiveness of telehealth-based lifestyle management programs in controlling diabetes compared to standard care that primarily relies on medications. The focus is on promoting healthier behaviors such as regular physical activity, dietary improvements, and psychological support. Outcomes of this investigation will provide insights into non-pharmacological strategies to prevent diabetes-related complications and improve overall glycemic control in adults (Gal et al., 2020).
Action Plan to Implement the Evidence-Based Project
Dietary Modifications
Personalized dietary counseling by registered dietitians will educate patients on balanced nutrition, portion control, and carbohydrate management. Resources such as meal planning guides, recipe collections, and educational handouts will support effective dietary interventions (Dobrow et al., 2022).
Increased Physical Activity
Individualized exercise plans will align with each patient’s fitness level, preferences, and medical history. Programs will integrate aerobic exercises, strength training, and flexibility routines into daily life to enhance overall health outcomes (Cornely et al., 2022).
Behavioral Support
Behavioral interventions, including Cognitive-Behavioral Therapy (CBT) and Motivational Interviewing (MI), will address psychological barriers and encourage sustainable behavior changes. Peer support groups, mentoring programs, and self-monitoring tools such as food diaries, activity trackers, and glucose logs will reinforce accountability and motivation (Cornely et al., 2022).
Proposed Timeline for Implementation
| Month | Activities |
|---|---|
| 1–2 | Develop telehealth educational materials and conduct provider training on lifestyle interventions. |
| 3–4 | Identify adult DM patients, conduct initial evaluations, and develop personalized dietary, exercise, and behavioral plans. |
| 5–6 | Implement interventions, monitor progress through regular follow-ups, and adjust plans as necessary. |
Tools or Resources Required
| Resource | Purpose |
|---|---|
| Dietitian Services | Telehealth-based dietary counseling and nutrition education (Gal et al., 2020). |
| Educational Materials | Guides on nutrition, physical activity, and behavioral strategies (Werfalli et al., 2020). |
| Exercise Facilities | Access to equipment and virtual exercise sessions. |
| Health Coaching | Training for providers to support behavioral modifications (Werfalli et al., 2020). |
| Self-Tracking Instruments | Food journals, mobile apps (e.g., MySugr), activity monitors, and glucose meters (Gal et al., 2020). |
| Peer Support Programs | Mentoring and support groups to foster accountability and motivation (Werfalli et al., 2020). |
This multi-component approach ensures feasibility and practicality. Telehealth interventions enhance access to dietary and physical activity guidance while supporting behavior change through evidence-based techniques (Sherazi et al., 2022).
Stakeholders, Innovation Opportunities, and Potential Barriers
Stakeholders Impacted
Adults with diabetes will actively participate in lifestyle interventions to improve glycemic control and reduce diabetes-related complications (Adhikari et al., 2021). Healthcare providers, including physicians, nurses, dietitians, and exercise specialists, will deliver interventions using telehealth platforms like MySugr. Local administrators and community organizations will collaborate to provide education, access to healthy foods, and opportunities for physical activity (Sherazi et al., 2022).
Areas Ripe for Innovation
Key innovation opportunities include the integration of technology to improve patient engagement and monitoring. Mobile apps and patient portals will track dietary intake, exercise, and glucose levels, providing real-time feedback and personalized guidance. Telehealth platforms increase accessibility, particularly for patients with mobility limitations or in rural regions. Collaborating with community organizations, such as the ADA, can extend interventions beyond hospital settings, addressing broader social determinants of health (Sharma et al., 2022).
Potential Barriers
| Barrier | Solution Approach |
|---|---|
| Knowledge gaps among providers | Comprehensive training in nutrition counseling, exercise, and behavioral techniques (Shi et al., 2020). |
| Time constraints | Optimize workflows and integrate interventions into routine care. |
| Technology access | Provide telehealth support and training for patients and providers. |
| Limited resources | Allocate budget, equipment, and personnel to sustain interventions (van Zyl et al., 2021). |
| Motivation and support | Engage leadership, providers, and community partners in planning and implementation. |
Specific Actions to Overcome Barriers
- Training and Education: Equip providers with skills in dietary counseling, exercise prescription, and behavior change interventions (van Zyl et al., 2021).
- Workflow Integration: Streamline care processes to ensure interventions fit within existing clinical schedules without disrupting patient care.
- Stakeholder Engagement: Involve patients, providers, administrators, and community partners throughout planning and implementation.
- Resource Allocation: Ensure necessary personnel, tools, and technology are available for effective intervention delivery (Adhikari et al., 2021).
Outcome Criteria and Measurement
Measuring Outcome Criteria
Outcome measures for this project include:
- Glycemic Control: Monitor HbA1c levels at baseline and throughout the intervention. A significant decrease indicates improved diabetes management (Sim & Lee, 2021).
- Behavioral Adherence: Assess adherence to dietary and exercise recommendations through validated surveys. Increased adherence demonstrates behavioral change (Sim & Lee, 2021).
- Hospital Admissions: Track admissions related to diabetes complications using electronic health records. Reduced admissions indicate better disease management.
- Patient Satisfaction: Evaluate patients’ perception of the intervention through surveys and feedback forms. Positive feedback indicates engagement and relevance (Dobrow et al., 2022).
Outcomes Alignment with the Quadruple Aim
The intervention aligns with the Quadruple Aim by improving patient outcomes, reducing costs, and enhancing provider well-being. Telehealth enables continuous education, reduces hospital readmissions, and promotes efficient healthcare delivery. Providers can manage their workload better, reducing burnout while enhancing patient satisfaction and health outcomes (Haverfield et al., 2020; Sherazi et al., 2022).
Search Strategies and Databases
A structured search strategy was used to gather evidence for this project. Electronic databases including PubMed, MEDLINE, CINAHL, and the Cochrane Library were utilized to retrieve peer-reviewed articles, systematic reviews, and clinical guidelines. Search terms included “diabetes mellitus,” “lifestyle interventions,” “glycemic control,” and “hospital setting.” Reference lists of relevant articles were also reviewed to ensure comprehensive coverage.
Inclusion criteria focused on adult patients with diabetes in hospital settings, with interventions targeting lifestyle modifications and glycemic control. Resources were critically appraised using the CRAAP criteria to ensure currency, relevance, accuracy, authority, and purpose (Ali et al., 2023). Articles highlighted the importance of interprofessional collaboration and non-pharmacological interventions to enhance diabetes management (Pasquel et al., 2021).
Summary of Findings
Evidence indicates that telehealth dietary counseling significantly improves adherence to nutrition plans, enhancing glycemic control (Dobrow et al., 2022). Structured exercise programs have been shown to increase physical activity and improve diabetic outcomes (Cornely et al., 2022). Behavioral support interventions, such as CBT and MI, effectively overcome psychological barriers and facilitate long-term lifestyle changes, contributing to better diabetes management (Sherazi et al., 2022). These findings reinforce the value of implementing a comprehensive, evidence-based, telehealth-focused diabetes intervention in hospital settings.
References
ADA. (2024). The burden of diabetes in West Virginia. diabetes.org. https://diabetes.org/sites/default/files/2024-03/adv_2024_state_fact_west_virginia.pdf
Adhikari, M., Devkota, H. R., & Cesuroglu, T. (2021). Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders’ perspective. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-11308-4
Ali, S. M., Bakht, Jan, Alam, I., Almajwal, A., Osaili, T. M., Obaid, F. M. E., Ismail, L., Najah, F., Radwan, H., Hasan, H., Hashim, M., Sharifa AlBlooshi, B. S., & Zeb, F. (2023). An innovative state-of-the-art health storytelling technique for better management of type 2 diabetes. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1215166
Al-Qerem, W., Jarab, A. S., Badinjki, M., Hyassat, D., & Qarqaz, R. (2021). Exploring variables associated with medication non-adherence in patients with type 2 diabetes mellitus. PLOS ONE, 16(8). https://doi.org/10.1371/journal.pone.0256666
NURS FPX 6011 Assessment 2 Evidence-Based Population Health Improvement Plan
Cornely, R. M., Subramanya, V., Owen, A., McGee, R. E., & Kulshreshtha, A. (2022). A mixed-methods approach to understanding the perspectives, experiences, and attitudes of a culturally tailored cognitive behavioral therapy/motivational interviewing intervention for African American patients with type 2 diabetes: A randomized parallel design pilot study. Pilot and Feasibility Studies, 8(1). https://doi.org/10.1186/s40814-022-01066-4
Dobrow, L., Estrada, I., Cooley, N., & Miklavcic, J. (2022). Potential effectiveness of registered dietitian nutritionists in healthy behavior interventions for managing type 2 diabetes in older adults: A systematic review. Frontiers in Nutrition, 8. https://doi.org/10.3389/fnut.2021.737410
Gal, R. L., Cohen, N. J., Kruger, D., Beck, R. W., Bergenstal, R. M., Calhoun, P., Cushman, T., Haban, A., Hood, K., Johnson, M. L., McArthur, T., Olson, B. A., Weinstock, R. S., Oser, S. M., Oser, T. K., Bugielski, B., Strayer, H., & Aleppo, G. (2020). Diabetes telehealth solutions: Improving self-management through remote initiation of continuous glucose monitoring. Journal of the Endocrine Society, 4(9). https://doi.org/10.1210/jendso/bvaa076
Haverfield, M. C., Tierney, A., Schwartz, R., Bass, M. B., Brown-Johnson, C., Zionts, D. L., … & Zulman, D. M. (2020). Can patient–provider interpersonal interventions achieve the quadruple aim of healthcare? A systematic review. Journal of General Internal Medicine, 35(7), 2107–2117. https://doi.org/10.1007/s11606-019-05525-2
Pasquel, F. J., Lansang, M. C., Dhatariya, K., & Umpierrez, G. E. (2021). Management of diabetes and hyperglycaemia in the hospital. The Lancet Diabetes & Endocrinology, 9(3), 174–188. https://doi.org/10.1016/s2213-8587(20)30381-8
Sharma, V., Feldman, M., & Sharma, R. (2022). Telehealth technologies in diabetes self-management and education. Journal of Diabetes Science and Technology, 18(1). https://doi.org/10.1177/19322968221093078
Sherazi, B., Laeer, S., Krutisch, S., Dabidian, A., Schlottau, S., & Obarcanin, E. (2022). Functions of mHealth diabetes apps that enable the provision of pharmaceutical care: Criteria development and evaluation of popular apps. International Journal of Environmental Research and Public Health, 20(1), 64. https://doi.org/10.3390/ijerph20010064
NURS FPX 6011 Assessment 2 Evidence-Based Population Health Improvement Plan
Shi, C., Zhu, H., Liu, J., Zhou, J., & Tang, W. (2020). Barriers to self-management of type 2 diabetes during COVID-19 medical isolation: A qualitative study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 13, 3713–3725. https://doi.org/10.2147/dmso.s268481
Sim, R., & Lee, H. (2021). Patient preference and satisfaction with the use of telemedicine for glycemic control in patients with type 2 diabetes: A review. Patient Preference and Adherence, 15, 283–298. https://doi.org/10.2147/ppa.s271449
van Zyl, C., Badenhorst, M., Hanekom, S., & Heine, M. (2021). Unravelling “low-resource settings”: A systematic scoping review with qualitative content analysis. BMJ Global Health, 6(6), e005190. https://doi.org/10.1136/bmjgh-2021-005190
Werfalli, M., Raubenheimer, P. J., Engel, M., Musekiwa, A., Bobrow, K., Peer, N., … & Levitt, N. S. (2020). The effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low- and-middle-income countries: A systematic review. Systematic Reviews, 9(1). https://doi.org/10.1186/s13643-020-01377-8