Enhanced Project Measures Worksheet

Trigger to Develop QI Initiative

The trigger of this quality improvement (QI) initiative is the endemic level of uncontrolled type 2 diabetes in adult patients in the outpatient clinical environment. Lots of patients still come to us with high levels of HbA1c despite treatment because they have some gaps in their self-management, so they have no access to organized education, and they do not receive consistent follow-up care. Ernawati et al. (2021) claim that active involvement in care and lifelong patient education are the keys to successful diabetes management. In reality, I have learned that patients tend not to have a clear insight into the direct impact of daily practices on the way glycemic control depends on what they eat and drink, whether they take medication, and engage in physical exercise. Such disconnection leads to preventable complications like neuropathy, cardiovascular disease, and hospitalization. These recurrent trends underscore the necessity of a systematic intervention, which is nurse-led and deals with knowledge gaps, as well as behavior conformity.

Purpose of the Proposed QI Project

This QI project will enhance glycemic control in adult patients with type 2 diabetes by establishing a structured nurse-led diabetes self-management education (DSME) program. Underwood et al. (2025) stress that DSME programs play a crucial role in enhancing patient knowledge, self-efficacy, and adherence to the treatment regimen. This program is aimed at making patients more empowered and confident about their ability to deal with their condition by embedding the necessary skills and confidence, minimizing the chances of developing complications, and enhancing their quality of health. Also, the project is expected to encourage the evidence-based, consistent nursing practice in the outpatient setting. This intervention aims to establish a lasting change in patient outcomes by tackling educational and behavioral differences as well as minimizing healthcare usage and the expense of care provision.

Intervention

The intervention proposed is an evidence-based, nurse-led, and structured self-management, diabetes self-management education (DSME) program, which is based on evidence-based clinical guidelines provided by the American Diabetes Association and the Centers for Disease Control and Prevention. The program will offer personalized and patient-focused learning and continuous education.

The intervention will include:

Education on monitoring and interpretation of blood glucose.
Tips on how to follow medication and use drugs correctly.
Nutritional counseling was geared towards glycemic control.
Physical activities: recommendations based on patient ability.
Teaching about prevention and early detection of diabetes complications.

The patients will be introduced to a program of teaching and followed up with periodic visits to enforce the learning process and review their progress. One-to-one education on medication adherence directly helps in meeting the objective of increasing medication adherence, and better understanding diet and glucose monitoring leads to better glycemic control. Follow-up serves as an assurance of continuity in care and helps to solidify behavioral change to control any disease in the long term.

Outcomes to Be Measured

Outcome 1: Reduction in HbA1c Levels

The key performance indicator will be a quantifiable change in the level of HbA1c of patients 3-6 months after the implementation of the DSME program. According to Roth et al. (2025), HbA1c is a vital indicator of long-term glycemic control and risk reduction. The project will focus on achieving at least a 0.5 reduction in the level of HbA1c among the participating patients in a clinically significant way. Such quantifiable enhancements lead to higher management of the disease and lower morbidity risk. The data will be gathered in an aggregate format without identifying patients in order to be up to date with HIPAA standards.

Outcome 2: Improvement in Medication Adherence

The second outcome will be an increase in patient medication adherence, which will be evaluated by self-reported methods of adherence, including structured adherence questionnaires, and with the assistance of pharmacy refill information as frequently as possible. As Patel et al. (2025) emphasize, enhanced compliance is tightly linked to enhanced clinical outcomes and decreased complication rates. The project shall also target an objective to record an improvement in the adherence rates, say, a 20 percent improvement in the score of adherences during the evaluation process. All the information will be coded and de-identified to keep the patients confidential and adhere to the standards of HIPAA.

References

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of Diabetes Self-Management Education (DSME) in Type 2 diabetes mellitus (T2DM) patients: Systematic Literature review. Journal of Public Health Research, 10(2). https://doi.org/10.4081/jphr.2021.2240

Patel, S., Huang, M., & Miliara, S. (2025). Understanding Treatment adherence in chronic diseases: challenges, consequences, and Strategies for improvement. Journal of Clinical Medicine, 14(17), 6034. https://doi.org/10.3390/jcm14176034

Roth, L., Steckhan, N., & Schwarz, P. E. H. (2025). Impact of a digital application on HbA1c levels in people with diabetes: a randomized controlled trial. Frontiers in Digital Health, 7, 1544668. https://doi.org/10.3389/fdgth.2025.1544668

Underwood, P. C., Ruscitti, B., Nguyen, T., Magny-Normilus, C., Wentzell, K., Watts, S. A., & Bowser, D. (2025). A Health Systems approach to Nurse-Led implementation of diabetes prevention and management in vulnerable populations. Health Systems & Reform, 11(1), 2503648. https://doi.org/10.1080/23288604.2025.2503648

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QI Project Measures Worksheet

QI Project Measures Worksheet

Directions:

Use this worksheet to complete the following items related to the QIP topic. Remove the italicized information and replace it with your own information about your QIP topic. This will be used next week to further develop the planning of your QI project.

IMPORTANT: You will NOT be collecting data. The purpose of developing and planning a QI project is to practice the important skill of using quality improvement methodology. As soon-to-be providers, you will be expected to lead QI initiatives.

Trigger to develop a QI initiative: Increased incidence of uncontrolled type 2 diabetes among adult patients in outpatient settings, as evidenced by persistently elevated HbA1c levels and poor adherence to self-management practices.
Purpose of the proposed QI project: The purpose of this project is to improve glycemic control among adult patients with type 2 diabetes by implementing a structured nurse-led diabetes self-management education (DSME) program to enhance patient knowledge, adherence, and overall outcomes.
Intervention: Implement a nurse-led Diabetes Self-Management Education (DSME) program based on clinical guidelines from the American Diabetes Association and Centers for Disease Control and Prevention.
Outcomes to be measured: What would you plan to measure/outcomes if you were to implement this QI initiative? Include two in the table below. Note the use of informatics concepts. Data is coded, and no patient identifiers are included. This meets Health Insurance Portability and Accountability Act (HIPAA) regulations. Also, demographics are included in publications so they can be replicated. However, no identifiers are included. HIPAA considers the following as patient identifiers: https://compliancy-group.com/18-hipaa-identifiers-for-phi/#:~:text=Patient%20names,Telephone%20numbers

List outcomes to be measured.	Identify how data will be collected for each outcome.
Reduction in HbA1c levels Pre-intervention average HbA1c = ___ Post-intervention average HbA1c = ___ Target: ≥ 0.5% reduction within 3–6 months	Review patients’ electronic medical records (EMRs) to collect and compare pre- and post-intervention HbA1c values. Data will be coded and de-identified to maintain HIPAA compliance.
Improvement in medication adherence Pre-intervention adherence rate = ___ Post-intervention adherence rate = ___ Target: ≥ 20% improvement in adherence	Use self-reported adherence tools and pharmacy refill data documented in EMRs. Data will be analyzed using coded, de-identified information to ensure confidentiality.
OPTIONAL: Demographics Age 1 = 18–30 2 = 31–50 3 = 51–65 4 = 66 or older Gender 1 = Male 2 = Female 3 = Other	Review patients’ EMRs using coded, de-identified demographic data