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Evaluating quality metrics of patients with type 2 diabetes managed by nurse practitioners in two family nurse practitioner-owned clinics

Wright, Wendy L. MS, ANP-BC, FNP-BC, FAANP, FAAN, FNAP (Owner)1; Bachmann, Jade P. BS, RN (FNP Student)2; Murphy, Nicole MS, APRN, FNP-BC (Nurse Practitioner)3; Gifford, Lauren MS, FNP-BC (FNP)1; Strowman, Shelley PhD (Associate Professor of Practice)2; White, Patricia PhD, ANP-BC, FAANP (Associate Professor)4

Journal of the American Association of Nurse Practitioners: July 2019 - Volume 31 - Issue 7 - p 413–419
doi: 10.1097/JXX.0000000000000195
Quality Improvement Report

Background: Diabetes is a major health concern in the U.S. with increasing prevalence. There are limited data on nurse practitioner (NP) roles in diabetes management and clinical patient outcomes in relation to national standards of care. This project aimed to identify rates of American Diabetes Association (ADA) guideline adherence of two NP-owned and operated practices during an ongoing four-year quality improvement project.

Methods: Methods: Electronic health records of 83 – 112 patients (depending on the year) ages > 18 years with type 2 diabetes were reviewed. Mean A1C and rates of adherence to ADA standards were compared from 2013 to 2017 and to national and state data.

Conclusions: Findings demonstrated that diabetes management provided by NPs consistently adhered to national ADA standards of care and met or exceeded national data. This four-year ongoing quality improvement project has led to the implementation of practice modifications that continue to improve patient outcomes through increased adherence to ADA guidelines.

Implications for practice: Strategies which improve adherence to ADA standards of care by NPs are essential. Identifying rates of adherence and implementing quality improvement strategies can significantly improve the quality of care provided to patients with diabetes.

1Wright & Associates Family Healthcare, Amherst, New Hampshire,

2Department of Nursing, Simmons College, Boston, Massachusetts,

3Core Physicians, Hampton Health, Internal Medicine, Hampton, New Hampshire,

4University of Massachusetts Worcester, University of Massachusetts Medical School, Graduate School of Nursing, Worcester, Massachusetts

Correspondence: Nicole Murphy, MS, APRN, FNP-BC, Hampton Health, 879 Lafayette Rd, Hampton, NH 03842. Tel: 603-686-2602; E-mail:

Authors' contributions: Development of quality improvement project: W. L. Wright and P. White. Collection and assembly of data: J. P. Bachmann, N. Murphy, and L. Gifford. Data analysis and interpretation: J. P. Bachmann, N. Murphy, L. Gifford, and S. Strowman. Manuscript preparation: J. P. Bachmann, L. Gifford, and N. Murphy. Manuscript review and revisions: W. L. Wright, J. P. Bachmann, S. Strowman, and P. White. Final approval of manuscript: W. L. Wright and P. White.

Competing interests: The authors report no conflicts of interest.

Received June 20, 2018

Received in revised form November 04, 2018

Accepted November 12, 2018

© 2019 American Association of Nurse Practitioners
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