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Increasing statin utilization in patients at high risk of atherosclerotic cardiovascular disease in remote physiological monitoring program
(Montana State University - Bozeman, College of Nursing, 2023) Ottemoeller, Christopher Michael; Chairperson, Graduate Committee: Lindsay Benes
Statement of the problem: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide costing the United States an estimated $200 billion a year. Dyslipidemia, a leading risk factor for ASCVD, is well controlled by statin medications. Despite high efficacy, low cost, and a favorable safety profile, statins are underutilized. A healthcare facility in Montana aimed to increase utilization of statins in high-risk populations through pharmacist chart reviews. Methods: The quality improvement case manager at the healthcare facility conducted a review of patient charts to identify those at high risk for ASCVD who were not receiving statin therapy based on MIPS #438 recommendations. The case manager identified patients that would benefit from a statin and referred them to a pharmacist for a medication chart review. The pharmacist then called the patient to complete a medication chart review and sent recommendations for medication changes to the patient's primary care provider (PCP). Results: Twenty-two patients were initially identified for statin therapy with 13 deemed eligible. Six of them (46%) agreed to a pharmacist chart review and were contacted by the pharmacist, all of whom agreed to statin therapy. The pharmacist made an average of two additional medication changes recommendations per review. Thus far, three patients followed up with their provider and started statin and one patient completed a repeat lipid panel. Conclusion: Pharmacist outreach can increase statin utilization in patients at high-risk of ASCVD. Further research should focus on improving statin tolerability and ability to contact patients.
Evaluation of interdisciplinary patient care conferences for the complex patient population in a rural state
(Montana State University - Bozeman, College of Nursing, 2021) Posada, Britt Kristen; Chairperson, Graduate Committee: Wade G. Hill
Primary care practice in the 21st century requires innovative and visionary transformation. With the prevalence of chronic diseases continuing to increase, the management of diseases and patients has to change in order to make an impact on outcomes and healthcare costs. As needs for primary care expand, the population ages and patient complexity increases, collaborative care is vital in providing optimum patient care. In 2018, the United States healthcare costs were $3.6 trillion, averaging $11,000 per person and are projected to increase to $6.2 trillion by year 2028. With care that is often fragmented between large hospital systems and community resources, rural states have shown that coordinated care teams have had a dramatic impact on healthcare costs. Monthly de-identified interdisciplinary patient care conferences were evaluated using the Collaborative Case Conference form. In the spring of 2021 an electronic survey was delivered to 18 historical participants of the interdisciplinary patient care conferences via email with goals of obtaining formative and summative evaluations. Formative evaluation found that 100% of participants responded Very Good-Excellent in usefulness of discussions as well as collaborative nature. The summative evaluation revealed that 93.34% of participants Agreed-Strongly Agreed that, as a result of the care conferences, they had a clearer sense of other health professionals roles. All participants reported that they Agreed-Strongly Agreed that there was greater value in interprofessional collaboration after participating in the conferences. Limitations of the evaluation included technology, recall bias, poor survey choices, and low scalability of project. In conclusion, the evaluation of the interdisciplinary patient care conferences for complex patients in a rural state was an overall success. Unfortunately, the program is no longer ongoing as it was halted after funding ended, making sustainability one challenge of convening statewide care conferences of this type. On a positive note, after the initiative was finished individual organizations did implement similar localized care conferences within their settings.
Preeclampsia and increased risk of cardiovascular disease: a practice guide for providers
(Montana State University - Bozeman, College of Nursing, 2020) Toole, Brielle Ashli; Chairperson, Graduate Committee: Sandra Benavides-Vaello
Cardiovascular disease (CVD) is the leading cause of death among women, however this disease is preventable and treatable. Extant evidence has established that women with a history of preeclampsia are at an increased risk for developing CVD later in life, and yet preeclampsia is under-recognized as a risk factor for CVD. This is due to a knowledge gap amongst healthcare providers, and subsequently providers are not adequately educating their patients with a history of preeclampsia about their CVD risk and reducing this risk. There are no specific guidelines regarding long-term care or screening for CVD in women with a history of preeclampsia, so a guideline needs to be developed to assist providers in caring for this high-risk population. The first aim of this project is to develop a guideline for providers to use in practice while caring for women with a history of preeclampsia, and the second aim is to enhance providers' knowledge of the link between a history of preeclampsia and increased CVD risk later in life so they can provide improved, evidence-based care. This project used a pre-survey, educational content with dissemination of two practice guidelines in different formats and a patient educational handout, and post-survey approach. The project targeted healthcare providers who care for women with a history of preeclampsia at a small rural hospital. Providers who participated in this project did have knowledge of the link between preeclampsia and increased CVD later in life, but were not applying this knowledge to their practice, as they neither took a thorough pregnancy history from their patients in regards to preeclampsia nor provided counseling to women with a history of preeclampsia about their increased risk of CVD. Providers who reviewed the guideline presented in this project found it helpful and had or planned to implement a practice change because of the guideline. The practice guideline developed was an effective tool to help the providers in this project implement evidence-based care into their practice, and the patient handout was an additional resource they could use to educate their patients with a history of preeclampsia.
Implementation of culturally sensitive and informed health education as a part of the 'wash approach' to controlling soil-transmitted helminth infections in the rural village of Bati Kelo, east Shewa Zone, Adama Wereda, Ethiopia
(Montana State University - Bozeman, College of Nursing, 2017) Dean, Courtney Elizabeth; Chairperson, Graduate Committee: Elizabeth Kinion
Problem Statement: A lack of population-specific approaches and interventions exist with regards to soil-transmitted helminth control measures, thus resulting in significantly reduced effectiveness and lasting impact. Purpose: The purpose of this clinical project was to develop and implement a culturally sensitive and informed health education program to address the health practices of a rural high risk population as a method for controlling soil-transmitted helminth infections. Methods: A culturally sensitive and informed health education program, utilizing the holistic method of the 'WASH Approach,' was implemented in the community of Bati Kelo, East Shewa Zone, Adama Wereda, Ethiopia. The project intervention consisted of three key components: 1) developing a culturally competent and population-specific KAP survey, 2) developing culturally competent health education material for the project population, and 3) conducting the KAP survey and health education sessions in a culturally competent manner. A convenience sample of 234 individuals was collected from the community. The project data were based on self-reported responses to the KAP survey. Ten key health behavior questions were utilized to evaluate the project: two on latrine usage, three on clean water usage, three on hand washing, and two on wearing shoes. Eighty-one surveys qualified for final inclusion. Data were analyzed using SPSS version 2.4. Descriptive statistics were utilized for the evaluation of the entire project. McNemar's test was used to analyze the differences between pre and post intervention (survey) results involving dichotomous variables. Wilcoxon's signed-rank test was used to analyze the differences between pre and post intervention (survey) results involving paired ordinal data. Findings: Positive health behavior/practice change was demonstrated post-intervention in the areas of 'latrine use,' 'clean water (treating water),' and 'handwashing;' however, it was not shown in the area of 'wearing shoes.' Conclusions: The overall findings of this clinical project were consistent with prior research studies, which found the WASH approach impactful on STH infection prevention measures (health behavior practices). A gap in the literature regarding 'cultural competence' in health education as a part of the WASH approach and STH control measures still exists. Much more inquiry and work still remains to be done.
Monitoring physical activity in persons living with fibromyalgia: a healthcare delivery innovations project
(Montana State University - Bozeman, College of Nursing, 2017) Kitchens, Kira Marie; Chairperson, Graduate Committee: Alice Running
Physical activity is an important component of symptom management in patients with fibromyalgia. A means to aid fibromyalgia patients in developing, monitoring and achieving physical activity goals may be useful in fostering resilience. The aim of the project was to explore the feasibility and acceptability of using a smart, wearable body sensor - the Fitbit One - to monitor physical activity in persons living with fibromyalgia. This project also explores use of the Fitbit One to examine the relationship between number of steps per week and fibromyalgia symptom impact. This healthcare delivery innovations project utilized a feasibility study design, where participants were asked to wear a Fitbit One for four consecutive weeks while performing their usual routines. Each week participants filled out the Revised Fibromyalgia Impact Questionnaire (FIQR), and at the end of the four-week period, the researcher interviewed participants about their experience wearing the Fitbit One. Participants (n=8) all identified as white females and had a previous diagnosis of fibromyalgia. Content analysis revealed three qualitative themes: 1) Device usability; a majority (n=7) felt the Fitbit One was easy to use 2) personal awareness; a majority (n=7) stated that the device increased their exercise awareness and 3) device feedback; most (n=6) participants felt that device feedback lead to physical activity goal setting. No participant felt that the device impacted pain. 7 of 8 participants' FIQR scores indicated decreased or unchanged symptom impact in daily living. Steps vs. FIQR graphs showed that for 6/8 participants the number of steps either increased or stayed the same, while self-reported fibromyalgia impact stayed the same or improved throughout the study. Findings suggest that Fitbit One use and wear are acceptable to individuals with fibromyalgia. Most participants cited increased awareness of physical activity as a benefit. Graphical analysis of steps compared to fibromyalgia impact suggests that increased steps may indicate decreased symptom impact. Given participants responses to usefulness and acceptability of the device, it seems that integration of smart, wearable body sensors into healthcare may be effective as another means to enable fibromyalgia self care.
Safety improvement in biologic therapy for patients with moderate to severe plaque psoriasis: a pilot project and quantitative analysis
(Montana State University - Bozeman, College of Nursing, 2016) Addison, Kara Marie; Chairperson, Graduate Committee: Jennifer Sofie
Biologic Response Modifier (BRM) medications are indicated for moderate to severe psoriasis and demonstrate high efficacy for disease reduction. Although BRM medications are considered the most effective therapy in the treatment of moderate to severe plaque psoriasis, their side effect profile can be severe. Using BRMs may increase the risk of infections, demyelinating disease, and malignancy (Reich, Burden, Eaton, & Hawkins, 2012). With such established risks, baseline assessments and monitoring have been recommended. However, no standardized guidelines exist for the monitoring of BRM medications (Hanson, Gannon, Khamo, Sodhi, Orr, & Stubbings, 2013). Therefore, the objective of this scholarly project was to implement a BRM monitoring protocol into the Electronic Medical Record (EMR) of a Montana dermatology clinic to improve provider monitoring compliance and therefore improve psoriasis patient outcomes, safety, and education. Monitoring criteria were developed based on recommendations from the University of Illinois Medical Center Clinical Care Guidelines and the American Academy of Dermatologists Biologic Monitoring guidelines. A BRM Electronic Medical Record (EMR) template was then created to utilize such guidelines to improve clinical compliance and patient safety. Seven main criteria were measured for completion including laboratory studies, physical assessment, patient education, follow up, psoriasis severity scale, immunizations, and vital signs. Side effects experienced and patient comorbidities were also recorded. Completion rates of the protocol were analyzed using before and after comparisons, the paired t-test, and McNemar's test. Before the intervention was implemented, 54% of charts had completion of all seven categories and after the intervention 98% of charts were completed, illustrating a 44% improvement in provider compliance and monitoring. The paired t-test illustrated an average difference of 0.43 with a standard error of .029. The McNemar's test established a positive association between implementation of the BRM protocol and improvement in provider compliance. 40% of patients experienced co-morbidities associated with psoriasis and 25% of patients experienced side effects related to BRM therapy. These project findings demonstrated the efficacy of a BRM monitoring template for improving provider-monitoring compliance and improving patient safety through early identification of comorbidities and side effects.
Cardiac services nurse residency
(Montana State University - Bozeman, College of Nursing, 2016) Kennedy-Collins, Kamera Machel; Chairperson, Graduate Committee: Alice Running
This professional project was born out of a specific need within the cardiac services department at Kalispell Regional Medical Center. In order to describe, and best determine the exact needs of the cardiac services department, a clinical microsystem assessment was completed for the department focusing on the 'five P's' of the assessment process; Purpose, Patients, Processes, Professionals, Patterns. Information obtained from the microsystem assessment highlighted the need for additional staffing. Factors such as retirement, department growth, and turnover have left the department chronically short staffed. Chronic short staffing has resulted in long work hours and routine overtime. Attempts at hiring experienced nurses have not been successful enough to meet the department demand. Evidence would support nursing residency programs as one solution to staffing shortages. Therefore, a literature review was completed regarding the design and success of nurse residency programs. Given the issues of persistent short staffing, and the subsequent increased work load for staff, a proposal for the development of a unit specific nurse residency program was made. This professional project proposes a 16 week unit specific nurse residency program designed to be integrated into the existing organizational program. The programs includes components of preceptorship, mentoring, and didactics. The goal of the proposed nurse residency program would be to provide education, professional support, and mentoring to new graduate nurses interested in cardiac care in order to satisfy long term staffing needs within the department.
Macular degeneration, glaucoma, and diabetic retinopathy : a continuing education program
(Montana State University - Bozeman, College of Nursing, 1999) Lewis, Amy Sarah; Chairperson, Graduate Committee: Jean Ballantyne
Acanthosis nigricans and risks for type 2 diabetes in children
(Montana State University - Bozeman, 2002) Mullenberg, Erin; Chairperson, Graduate Committee: Vonna Branam
The efficacy of the coronary patient's hospital record in research
(Montana State University - Bozeman, College of Professional Schools, 1970) Sprague, Mildred Grow; Chairperson, Graduate Committee: Rita M. Darragh

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