DNP 752 Week 3 Results With Tables and Figures Example

Results of the Distress Check and Response Pilot: Four Tables and Two Run Charts Describing Screening, Follow-Up, Distress Change and Staff Experience

[Student Name]

University of Phoenix

DNP/752: DNP Applied Project III

Week 3 Assignment: Results Section

[Instructor Name]

[Date]

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

Participants and Intervention as Delivered

During the 12-week pilot, 219 adults with type 2 diabetes attended 231 eligible visits at the clinic. Their median age was 58 years, 57% were women, 16% preferred Spanish and 38% used insulin. In the 12 baseline weeks, 203 patients attended 214 eligible visits and none was screened for diabetes distress. Following the SQUIRE 2.0 expectation that reports describe the intervention in the form patients actually received it (Ogrinc et al., 2016), the pathway is summarized here: it ran as described in the proposal with three documented changes: a one-week delay in the start, next-day telephone contact by care managers from week 5, and the addition of community health worker referral as a response option.

Process Outcomes

Table 1 summarizes process outcomes by improvement cycle. Screening rose from 61% in cycle one to 93% in cycle three, for 81.4% across the pilot. Timely follow-up reached 85.2% overall.

Table 1. Process Outcomes by Improvement Cycle

Cycle one (weeks 1 to 2): 38 eligible visits; 23 screened (61%); 2 declines; median added rooming time 2.0 minutes.

Cycle two (weeks 3 to 6): 81 eligible visits; 61 screened (75%); 4 declines; median added rooming time 1.5 minutes.

Cycle three (weeks 7 to 12): 112 eligible visits; 104 screened (93%); 5 declines; median added rooming time 1.5 minutes.

Whole pilot: 231 eligible visits; 188 screened (81.4%); 11 declines (4.8%); 61 positive screens; 57 full scales completed (93%); 52 contacts within 14 days (85.2%).

Note. Rooming time was measured on 20 timed visits per cycle. Declines are visits at which the patient chose not to answer.

Run Charts

Figure 1, the weekly screening run chart, shows the pilot rate against a median line of 67% taken from the first four weeks. Seven consecutive points from week 6 to week 12 lie above the median, a shift, and weeks 5 to 9 rise five times in a row, a trend. Both signals begin after the cycle two changes. Figure 2, the weekly chart of timely follow-up, has its median line at 78%, and from week 5 onward six weekly values in a row sit over it. The median time to first care manager contact was nine days before week 5 and three days after.

Distress Outcomes

Table 2 presents full-scale scores for the 44 patients with both assessments.

Table 2. Diabetes Distress Scale Scores at Entry and at 12 Weeks (n = 44)

Mean item score at entry: 3.02 (SD 0.61).

Mean item score at 12 weeks: 2.48 (SD 0.66).

Mean change: -0.54, paired t(43) = 6.40 (p < .001), 95% CI from -0.71 to -0.37, Cohen's d = 0.96.

High distress (3.0 or above): 20 patients at entry; 9 at 12 weeks.

Note. Scores are mean item scores on a 1 to 6 scale; high distress follows published cut points (Fisher et al., 2012).

Of the 44 patients, 36 had lower scores at 12 weeks, 5 had higher scores and 3 were unchanged.

Table 3. Change in the Dominant Subscale by Domain at Entry

Regimen-related (n = 19): 3.31 at entry; 2.52 at 12 weeks.

Emotional burden (n = 14): 3.46 at entry; 2.94 at 12 weeks.

Two smaller groups, 6 patients with mainly physician-related distress and 5 with mainly interpersonal distress, are reported as counts only.

Care Manager Responses

The 52 patients reached within 14 days received 57 responses: problem-solving support for the treatment routine in 27 cases, a goals review with the clinician in 7, family or peer resources in 6, an in-person introduction to the behavioral health consultant in 14 and a community health worker referral in 3. Two patients reported thoughts of self-harm on the PHQ-9; both were assessed the same day under the safety protocol.

Fidelity Results

Of the 61 positive screens, 57 had a completed full scale, 52 had a care manager contact within 14 days and 49 had a documented response matched to the dominant subscale; in three cases the care manager chose a different response after talking with the patient, and the reason was recorded. The champion observed 15 screening encounters, 13 of which followed the scripted introduction and private handover of the tablet.

Characteristics by Screening Result

Patients who screened positive were younger than those who screened negative (median age 55 compared with 60 years), more likely to use insulin (50% compared with 32%) and more likely to have a most recent A1C above 9% (59% compared with 36%). The proportion of women was similar in both groups. These figures describe who screened positive; they do not show that any characteristic causes distress.

Timeline of Results

Screening and timely follow-up both improved in steps rather than gradually. Screening moved from about six in ten visits in the first two weeks to three in four once the introduction was shortened, then above nine in ten once phone completion was added. Follow-up changed once, sharply, when next-day calls began in week 5. Rooming time fell from two added minutes in cycle one to one and a half minutes thereafter and stayed there.

Subgroups

Table 4. Screening and Positivity by Subgroup

English preferred: screening 82%; positive 34%.

Spanish preferred: screening 76%; positive 31%.

Using insulin: screening 83%; positive 44%.

Not using insulin: screening 80%; positive 29%.

Staff Implementation Scores

Fourteen of 15 staff completed the three implementation measures after cycle three (Weiner et al., 2017). Acceptability averaged 4.3, appropriateness 4.4 and feasibility 3.9 on the five-point scales. After cycle two, the same scores were 4.1, 4.3 and 3.6.

Exploratory A1C

Among 38 patients with values before and after, median A1C was 9.4% before the first positive screen and 9.0% at the first value drawn 12 or more weeks afterward. No test was performed.

Unintended Consequences

Behavioral health consultant referrals rose from an average of two a week to four a week during cycles two and three. One medical assistant reported feeling rushed on afternoons with double-booked slots. No patient complaint was filed, and no visit was delayed by more than five minutes according to the timed sample. The behavioral health consultant absorbed the added referrals within existing hours but noted that two more a week would require protected time. Care managers logged about 22 additional hours of follow-up across the pilot, close to the estimate in the proposal, and neither reported postponing other high-risk patients to make room.

Summary of Results

The pilot met its process targets, distress fell among patients with repeat scores, and staff rated the pathway favorably. The meaning of these results, weighed against the literature and the decision rules set in the proposal, is discussed in the next section.

References

Fisher, L., Hessler, D. M., Polonsky, W. H., & Mullan, J. (2012). When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale. Diabetes Care, 35(2), 259-264. https://doi.org/10.2337/dc11-1572

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

Weiner, B. J., Lewis, C. C., Stanick, C., Powell, B. J., Dorsey, C. N., Clary, A. S., Boynton, M. H., & Halko, H. (2017). Psychometric assessment of three newly developed implementation outcome measures. Implementation Science, 12, Article 108. https://doi.org/10.1186/s13012-017-0635-3