NURS FPX 9040 Assessment 1 Manuscript with Abstract

NURS FPX 9040 Assessment 1 Manuscript with Abstract Student Name Capella University NURS-FPX9040 Doctor of Nursing Practice 5 Professor Name Submission Date   Abstract A considerable gap in the outpatient primary care setting exists in glycemic control in adults with type 2 diabetes, and this non deal control is mostly attributable to lack of follow-up, insufficient patient education, and inadequate medication management. The percentage of patients with HbA1c >9% (42%) at the project site was higher than the national average of 22% of U.S. adults with diabetes (Adjei et al., 2025; APRN, personal communication, November 2025). The PICOT question that guided the research was: For the diabetes nurse who cares for diabetes adults (P), what is the effect of using the ADA diabetes follow-up protocol (I) versus current practice (C) on glycemic control (O) over 8 weeks (T)? The quality improvement project deployed a structured follow-up protocol for eight weeks, in an outpatient primary care environment, which was designed to be ADA compliant. The interdisciplinary implementation team comprised nursing professionals and health care providers who were educated and trained in structured learning sessions about diabetes management and the use of EHRs. In bi-weekly follow-up visits, adult patients with type 2 diabetes were involved. Evaluation focused on HbA1c levels, visit frequency, and adherence monitoring through tools in the EHR. There was a clinically meaningful mean change in HbA1C of 1.52 percentage points (9.95% to 8.22%), which is more than the success criterion of 0.5%. Adherence to follow-up was good, with 89.2% of visits completed. The HbA1c goal of <7% was not reached by 10% of the people within 8 weeks. The results of this structured ADA follow-up protocol were shown to be clinically beneficial for glycemic control, which proves the PICOT hypothesis. Results indicate that nurse-driven, protocol-based care has a positive impact on diabetes care. There may be a need for longer intervention time for optimal target achievement, however. The project helps to sustainably integrate more standardized follow-up protocols to improve chronic disease outcomes in primary care. Keywords: Diabetes Management, HbA1c Reduction, Nurse-Led Intervention, Outpatient Primary Care, Quality Improvement, Follow-Up Protocol. Table of Contents Improving Glycemic Control in Adult Patients with Type 2 Diabetes Through Implementation of a Structured ADA Diabetes Follow-Up Protocol in an Outpatient Primary Care Setting. 5 Practice Problem.. 5 Project Site. 8 Project Population. 10 Evidenced-Based Interventions. 12 Role of the Project Lead. 16 Roles of Other Team Members. 17 Literature Synthesis. 18 Analysis of Evidence. 20 Theme 1: ADA Guideline Adherence and Clinical Practice Standards. 22 Theme 2: Nurse-Led Interventions and Staff Competency Development 24 Theme 3: Diabetes Self-Management Education and Support Interventions. 26 Theme 4: Technology-Enhanced Diabetes Care and Remote Follow-Up Protocols. 28 Synthesis of Findings. 30 Implementation Plan for the Intervention. 31 Conceptual Model 33 Data Collection and Analysis. 35 Ethical Considerations. 37 Project Results. 39 Project Outcomes. 40 Recommendations. 43 Summary. 44 Appendix A.. 58 Demographic Characteristics and Baseline HbA1c (N = 20) 58 Appendix B.. 60 HbA1c Outcomes Across Measurement Time Points (N = 20) 60 Appendix C.. 62 Follow-Up Adherence and Visit Completion Data (N = 20) 62 Appendix D.. 64 Nursing Staff Competency Assessment Results (N = 8) 64 Appendix E.. 65 Self-Management Behavior Checklist — Week 8 (N = 20) 65 Appendix F. 67 Summary Statistics: Project Implementation Outcomes. 67 Improving Glycemic Control in Adult Patients with Type 2 Diabetes Through Implementation of a Structured ADA Diabetes Follow-Up Protocol in an Outpatient Primary Care Setting The failure to provide standardized and protocoled pathways for follow-up is a significant gap in practice that is present across outpatient primary care settings, which also has the potential for missed opportunities for education, non-standardized medication review, and preventable complications amongst adult patients with type 2 diabetes mellitus. The project site had 42% of adult patients with hemoglobin A1c levels > 9%, and only 36% with levels < 7%, which are far from national targets, where 38% of U.S. adults with diabetes have hemoglobin A1c levels < 7% (Adjei et al., 2025; APRN, personal communication, November 2025). Implementation gaps remain in follow-up, staff competency, and structured patient education of nurse-led diabetes care throughout primary care settings despite the established clinical practice guidelines of the American Diabetes Association. The PICOT question for this project is: In the care of the adult patient with diabetes (P), does the use of the ADA diabetes follow-up protocol (I) improve glycemic control (O) over 8 weeks (T) compared to the use of current practice (C)? A systematic follow-up routine with structure for a procedure that is compatible with the ADA, along with staff competence building and patient education on self-management, will result in clinically significant improvements in glycemic outcome and move the field of chronic disease management towards evidence-based practice in the outpatient primary care setting. Practice Problem Chronic disease management in outpatient primary care should be a systematic, evidence-based approach that has been shown to close the gap between glycemic control of adults with type 2 diabetes and the desired health system benchmarks. Based on the site-level data from the outpatient primary care clinic, 42% of all the adult patients had HbA1c levels above 9%, while 36% had levels below 7% (APRN, personal communications, November 2025). The national performance data for the adult population with diabetes is also very poor – almost one in every five (22%) adult diabetes patients with a history of diabetes are not well controlled, and nearly half (45%) of all adult diabetes patients worldwide have never reached an HbA1C below 7% – which is a significant gap when compared to established benchmarks from health systems (Adjei et al., 2025; Dinavari et al., 2023). The poor metabolic control of 1 in 4 adults in the U.S. and Europe is reflected by a hemoglobin A1c value of more than 9% (Gomes et al., 2022). In adults attending an outpatient diabetes clinic, low glycemic control is largely attributed to behavioral and demographic risk factors, and the need for early identification of those at greater risk