DNP 752 Week 1 Implementation and Data Collection Progress Report Example

Twelve Weeks in the Exam Rooms: An Implementation and Data Collection Report on the Diabetes Distress Pilot, Including What Changed Along the Way

[Student Name]

University of Phoenix

DNP/752: DNP Applied Project III

Week 1 Assignment: Implementation Progress Report

[Instructor Name]

[Date]

The health center, staff and figures are composites written for a model paper.

Purpose of This Report

The Distress Check and Response pilot ran for 12 weeks at the health center's east side clinic, in the implementation interval between the proposal course and this course, after both the university committee and the health center's quality committee determined that it was quality improvement. Data collection closed eight days ago. This report compares what happened with what the proposal planned, describes the changes made during three improvement cycles, and confirms which data are complete enough for analysis next week.

Planned Compared With Actual Timeline

The proposal set the first pilot week one week after the final training session. The actual start was two weeks after training, because the electronic health record analyst was pulled onto an urgent billing project and the automatic prompt that opens the 17-item scale after a positive screen was not ready. The team chose to wait one extra week rather than start on paper, since paper forms would have required manual entry and risked lost scores. All other milestones held: baseline data were extracted on schedule, the three cycles ran as planned, repeat scales were collected in weeks 9 through 12, and staff surveys were given after cycles two and three.

Phases One and Two: Awareness and Preparation

All 15 clinical staff attended the all-staff presentation or its recording. Fourteen completed role-specific training before launch; the fifteenth, a physician on leave, completed a one-on-one session in pilot week 2. The medical assistant champion, a medical assistant with six years at the site, was appointed in the preparation phase and trained a backup. Spanish versions of both instruments were reviewed by two certified interpreters, who changed one phrase in the screener's second item to match local usage.

Cycle One (Pilot Weeks 1 and 2)

Each cycle began from the previous one's findings and used weekly counts, avoiding the unlinked, data-poor cycles that Taylor et al. (2014) found common in published improvement work.

Plan: one medical assistant and one nurse practitioner would use the pathway for all eligible visits. Prediction: at least 70% of their eligible visits would include a completed screen. Result: 23 of 38 eligible visits, 61%, had a completed screen. The champion's timing showed a median of two minutes added to rooming, and the medical assistant reported that explaining the questions took longer than expected. Action: the team shortened the introduction to one sentence printed on the tablet's first screen and moved the screen before vital signs, so patients answered while the medical assistant prepared the blood pressure cuff.

Cycle Two (Weeks 3 to 6)

Plan: extend the revised workflow to all morning clinics. Prediction: 75% screened, rooming time under 1.5 added minutes. Result: 61 of 81 eligible visits, 75%, screened; median added time 1.5 minutes. Positive screens rose faster than care managers expected in week 4, when a cluster of patients starting insulin screened high. The Friday huddle that week produced the most useful change of the pilot: care managers began calling patients the day after a positive screen instead of waiting for a clinic slot, which cut the median time to first contact from nine days to three.

Cycle Three (Weeks 7 to 12)

Plan: extend to all clinics and add phone completion of the full scale for patients who left before finishing. Prediction: 80% screened. Result: 104 of 112 eligible visits, 93%, screened. Over the whole pilot, 188 of 231 eligible visits, 81.4%, included a completed screen, 11 visits (4.8%) ended in a decline and 32 were missed.

Fidelity

Of 61 positive screens, 57 (93%) led to a completed 17-item scale, and 52 (85%) were reached by a care manager inside the 14-day window. The champion observed 15 screening encounters across the three cycles; in 13 the introduction followed the script and the tablet was handed over privately, and in two the medical assistant read the questions aloud in a shared hallway, which prompted a reminder at the next huddle. Both events reported through the self-harm safety protocol were handled as written, with same-day assessment and a care manager call within 48 hours.

Data Completeness

Weekly screening reports: 12 of 12 received, enough points to read the run charts with the standard rules for shifts, trends and runs (Perla et al., 2011). Baseline extraction: 12 weeks, 214 eligible visits, complete. Full-scale scores: 57 first scores; 44 repeat scores at 12 weeks (77%), with 13 patients unreachable or lost to follow-up. Care manager encounters: complete for all 61 positive screens. Rooming times: 60 timed visits, 20 per cycle. Staff surveys: 14 of 15 returned after cycle two and 14 of 15 after cycle three. A1C: 38 patients with values before and after, as expected for an exploratory measure.

Barriers and Responses

Four barriers appeared. The analyst delay has been described. Tablet batteries ran down by mid-afternoon in two exam pods during week 5, so screens were missed on late visits; chargers were moved into the pods. A medical assistant resigned in week 8, and the backup champion trained the replacement within three days, with no drop in that week's rate. Finally, several patients who prefer Spanish asked what "regimen" meant in the translated handout, and the interpreters replaced the term with a plainer phrase for the second printing.

What Patients Said

Care managers recorded patients' comments during follow-up calls. The most common was surprise that the clinic had asked. Several patients said the second screening question, about feeling that they were failing with their diabetes routine, described exactly how they felt at every visit. Two patients said the questions felt intrusive, and both declined the full scale, which was recorded as a decline.

Deviations From the Proposal

Three deviations will be reported in the manuscript, as the SQUIRE 2.0 guidelines ask for any change to a planned intervention (Ogrinc et al., 2016). The start was delayed one week. Care manager first contact moved from the next clinic slot to a next-day phone call. A third response option, referral to the community health worker for social needs, was used for three patients, as the framework section had anticipated but the response guide had not formally listed.

Leadership Reflection

The hardest moment was week 4, when positive screens outpaced the care managers and the team considered pausing. Bringing the weekly data to the huddle, rather than deciding alone, produced the next-day call solution and kept the pilot going.

Readiness for Analysis

All data sets needed to answer the practice question are complete or have documented gaps. Analysis of run charts, paired distress scores, staff measures and subgroups will proceed next week.

References

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290-298. https://doi.org/10.1136/bmjqs-2013-001862