Theses and Dissertations at Montana State University (MSU)
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Item A quality improvement initiative on asthma management in a family medicine setting(Montana State University - Bozeman, College of Nursing, 2022) Wing, Nicole Morin; Chairperson, Graduate Committee: Margaret HammerslaAchieving control of asthma symptoms can improve quality of life and reduce hospitalizations. Clear clinical practice guidelines from the National Heart Lung and Blood Institute's Expert Panel Report 3 (2007) detail critical components for optimal asthma management. One component, the Asthma Control Test (ACT), is a standardized tool used to assess asthma control. Another component, the Asthma Action Plan, is an individualized plan formulated by the provider for asthma patients to help self-manage asthma. Problem: Organizational stakeholders at a family medicine clinic in southwest Montana identified that there was no standardized workflow for asthma management. The clinic has 1,238 asthma patients. In the past year, none have had asthma control assessed using a standardized tool, and only one patient has had an Asthma Action Plan completed. Methods: After collaboration with stakeholders, a brief educational intervention for providers and rooming staff and a new workflow to implement ACT screening and asthma action plan were developed. Electronic medical record reports and chart audits were used to monitor the completion of the ACT and Asthma Action Plans. A series of five one-week Plan-Do-Study-Act (PDSA) cycles were run to work toward goals of 100% completion of ACT at office visits, 100% of uncontrolled ACT scores addressed, and 80% of uncontrolled scores addressed with Asthma Action Plans. Results: During the first five weeks of the new workflow, 49 alerts were fired for ACT completion; 36 ACT screens were completed (73%); by the fifth week, rates increased steadily to 88.9%. Only six ACT screens revealed uncontrolled asthma; providers directly addressed 100% of those scores. None of those patients had an Asthma Action Plan completed; however, six other patients with well-controlled asthma did during this timeframe. Conclusions: While the project cannot assume the workflow improved outcomes for asthma patients, significant steps to adhering to clinical practice guidelines were made by introducing ACT screening and Asthma Action Plans. More work is needed to increase adherence to the new workflow, particularly Asthma Action Plan completion rates. Additionally, the clinic is now open to introducing additional elements of asthma guidelines in the future, such as peak flow meter use.Item A formalized approach to remedy tobacco addiction: e-referrals and the ability of documentation to influence opportunities through motivational interviewing(Montana State University - Bozeman, College of Nursing, 2021) Hoffman, Matthew Douglas; Chairperson, Graduate Committee: Casey ColeIt is an understatement to report that there is an inconsistent approach for tobacco cessation therapy (TCT) techniques, and this is negatively affecting those with the desire to pursue cessation. Therefore, it is long overdue to better address and incentivize a more consistent quality improvement process to remedy the multifaceted dynamic of tobacco cessation (TC). According to the World Health Organization (WHO) tobacco globally affects 1.2 billion people, and annually imposes an economic damage of $500 billion worldwide (Caponnetto et al., 2019; Epku & Brown, 2015; Gonzales et al., 2020). With attention to detail in the foreground of billing, coding, and documentation, it is anticipated that increased opportunities for a more formalized approach to remedy tobacco addictions through motivational interviewing (MI) have been encouraged. Ultimately, this project guided a synergistic effect between the financial integrity of the medical clinic and the health of the rural Montana population that it serves. In a small rural family medicine clinic and over a six-week timeframe, a provider instituted basic MI techniques to enroll patients interested in TCT via an electronic (e-Referral) to the Montana Tobacco Quit Line (MTQL) to remedy tobacco addiction. Data collection was facilitated and contained within the EPIC EHR system, monitoring the number of known tobacco users, ready to quit statuses, and those both currently and newly enrolled for counseling with an e-Referral to the MTQL. Prior to the project's implementation, a total 23 patients were known as tobacco users at this clinic, two of which were being counseled; three new e-Referrals submitted increase the total to five. Nonetheless, there are now 51 patients that are newly known tobacco users after this project's screening and documentation. The thematic underpinnings that surfaced include a lack of healthcare engagement with documenting tobacco users and the need for continued pursuit of TCT. The generalization that this data infers is that the rural population at this clinic is asking for help, but the health system is not responding adequately.Item Implementation of Lean management in family practice to decrease overall clinic visit time(Montana State University - Bozeman, College of Nursing, 2020) Quist, Rochelle Eileen; Chairperson, Graduate Committee: Angela JukkalaVariations in the patient rooming process have created inefficient practices for staff in a clinic setting. Negative impacts from these variations have been correlated with increased patient wait times, delayed patient care and decreased patient satisfaction. Through patient complaints with frustrations in delayed care and wait times, this scholarly project found discrepancies in the patient flow process. Variations existed within several primary care patient settings based on individual provider training and personal habits, style, and preferences. Utilizing Lean Management ideals to improve rooming and throughput were strongly indicated within recent healthcare journals as a means to reduce waste and improve efficiency in patient care processes. Developing interventions based on Lean Management principles discovered in the literature review will be outlined for execution. Following implementation of interventions, a follow up time study will be completed to compare to the original data, as well as repeat patient satisfaction surveys. This scholarly project expands nursing knowledge by addressing the gaps in past studies by examining throughput in an outpatient clinic setting, potentially decreasing patient wait times, delays in care and increasing patient and provider satisfaction.