title: Quality improvement and changes in diabetic patient outcomes in an academic nurse practitioner primary care practice.
abstract: OBJECTIVE
  To examine a set of system interventions in the management of patients with diabetes and the outcomes of their care.
  
  
  METHODS
  Preintervention and postintervention data collected from electronic medical records.
  
  
  CONCLUSIONS
  The sample size was smaller than expected, contributing to a lack of statistical significance from preintervention to postintervention in the patient outcome measures. The systems-level variables that were under the direct control of the clinic staff (e.g., pneumococcal vaccine given) showed great improvement. In the preintervention period, the percentage of "yes" responses to the system-level variables ranged from 8 to 24 and jumped to 16 to 95 after the intervention.
  
  
  CONCLUSIONS
  Unequivocally, this project demonstrated that systems-level changes result in improved care being provided to patients; however, these had minimal impact on the patient outcome variables. Promoting change in patient behavior is difficult, which may have contributed to the lack of significance in this area, while the variables under the direct control of the clinic staff were more easily changed.
authors.affiliation: UT Health Services, University of Texas Health Science Center at Houston, TX, USA. thomas.a.mackey@uth.tmc.edu
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Mackey
authors.forename: Frank L
authors.initials: FL
authors.lastname: Cole
authors.forename: Julie
authors.initials: J
authors.lastname: Lindenberg
mesh_terms: D003920:Diabetes Mellitus / Q000378:metabolism / Q000517:prevention & control*; D004509:Education, Nursing, Continuing; D022143:Family Nursing / Q000458:organization & administration; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007318:Inservice Training; D016294:Models, Nursing; D020380:Needs Assessment; D009722:Nurse Practitioners / Q000193:education / Q000458:organization & administration*; D024802:Nurse's Role; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D009734:Nursing Faculty Practice / Q000458:organization & administration*; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D018401:Sample Size; D013597:Systems Analysis; D013781:Texas; D017749:Total Quality Management / Q000458:organization & administration*
chemical_list: D006442:Glycated Hemoglobin