Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Improving blood pressure screening and control in primary care: a quality initiative(Montana State University - Bozeman, College of Nursing, 2023) Gomendi, Wendy Michelle; Chairperson, Graduate Committee: Molly SecorBackground: Hypertension costs the United States healthcare system billions of dollars and accounts for 1 in 6 deaths annually. Management of hypertension is a priority in primary care settings. Strategies to prevent the adverse health effects of hypertension in the United States include increasing awareness of the health risks of uncontrolled hypertension, promoting the use of healthcare teams to manage hypertension, and empowering patients to use self-measured blood pressure monitoring. Local Problem: To address the high rate (58%) of uncontrolled hypertension at a family practice clinic in Montana, a QI project was implemented aimed at improving blood pressure screening, management, and control. Methods: The Knowledge to Action model guided the development of a workflow that incorporated an existing hypertension management policy based on USPSTF hypertension screening and management recommendations. Interventions: Interventions were implemented over four weeks. All patients presenting to the clinic with a blood pressure > or = 140/90 were rescreened at the end of the visit. If the blood pressure remained elevated, the clinic staff was asked to provide an informational packet and ask the patient to obtain home blood pressure measurements or return in 7-14 days for a blood pressure check. Individuals with three elevated blood pressures on three separate occasions were referred to their care team for further hypertensive management. Results: The project goals were not achieved; however, the percentage of hypertensive patients with a blood pressure > or = 140/90 decreased by 4%. Conclusion: The QI initiative resulted in a modest increase in hypertension control for the project site. Although goals were not met, the project provided insight into hypertension management barriers, including time constraints on the providers and staff, patient willingness to engage in serial blood pressure measurements, and readiness of providers and patients to escalate hypertensive medication therapy.Item Undiagnosed hypertension in rural healthcare(Montana State University - Bozeman, College of Nursing, 2023) Charlo, April Lee; Chairperson, Graduate Committee: Sandra Benavides-VaelloHypertension is a disease that affects numerous people worldwide. It often goes undiagnosed, causing an increased risk of cardiovascular events. This project aimed to reduce the number of patients with undiagnosed hypertension within the observed population. This project occurred within a network of clinics associated with a 25-bed critical access hospital in rural Western Montana. Participants included clinic staff, physicians, nurse practitioners, physician assistants, registered nurses, licensed practical nurses, medical assistants, and a licensed clinical social worker. The Plan-Do-Check-Act was used as the framework for this quality improvement (QI) project. Hypertension was defined using the 2017 American College of Cardiology and American Heart Association Clinical Practice Guidelines. The Electronic Medical Record system was used to identify out-of-range blood pressures in the last 2 years and add these patients to a registry. Clinical personnel performed chart reviews to eliminate patients who did not meet the criteria defined by the stakeholders. EHR message functionality alerted providers offering to schedule patients for an office visit to rule in or out hypertension. The identified patients were contacted by a licensed clinical social worker and invited to schedule an appointment with a provider to address the possibility of undiagnosed hypertension. The final numbers were assessed 6 weeks after the undiagnosed hypertension project implementation. The multistep PDCA process resulted in a significant reduction in the overall number of potentially undiagnosed hypertensive patients. The initial data collection produced 3,617 patients between the ages of 18 and 85, and the last revealed only 1,210 patients that met the criteria. The most significant decrease in number was seen in the 56-65 age group, dropping from 700 to 188 patients. This quality improvement project aimed to identify potentially undiagnosed hypertensive patients and establish a system to assess those patients by a provider. This project accomplished that objective. This quality improvement project was structured on innovative research, a trusted conceptual framework, and current practice guidelines. If the quality improvement team were to extend this project, the next step would be implementing clinical practice guidelines and monitoring hypertension outcomes within the patient population.Item A quality-improvement project on the implementation of health coaching for hypertension control in primary care(Montana State University - Bozeman, College of Nursing, 2022) Udayakumar, Kasthuri; Chairperson, Graduate Committee: Lindsay BenesHypertension is a major contributing factor to cardiovascular disease and stroke (Center for Disease Control and Prevention [CDC], 2021). The prevalence of hypertension in the United States is high and increasing in Montana. Although hypertension is a condition that can be diagnosed and treated easily in primary care settings, a large proportion of individuals live with undiagnosed and uncontrolled hypertension in the United States and in Montana. Given the health disparities among underserved rural populations, there was a need to develop accessible and low-cost improvement efforts (Sharma et al., 2016) in primary healthcare settings in rural Montana. The aim of this quality-improvement project was to implement health coaching, a promising evidence-based improvement strategy to prevent uncontrolled hypertension in a rural primary care clinic in North Central Montana. Health coaching has demonstrated significant improvement in outcomes in patients with chronic disease conditions such as hypertension (Finn & Watson, 2017; Sharma et al., 2016; Singh, 2021). The project helped to create a patient centered, efficient, adoptable, and sustainable improvement effort that supported self-management of hypertension. Health coaching was implemented in this project through members of the healthcare team, such as registered nurses and medical assistants, by four 30-minute visits including face-to-face and telephone calls for a period of 5 weeks. The Donabedian's structure, process, and outcome framework guided the design of the project and measurement of project outcomes. The outcome of the project demonstrated improvement in blood pressure to less than 140/90 mm Hg following 5 weeks of health coaching. This project was implemented in the clinic as a pilot program with the support of healthcare professionals and administrators from multiple levels. Future recommendations for practice were developed from this project to help inform and support sustainability of future health-coaching interventions on a larger-scale basis in rural settings.Item Sodium in drinking water and adolescent blood pressure(Montana State University - Bozeman, College of Nursing, 1981) Forseth, Jean Charlotte