A Quality Improvement Project to Improve Self-Efficacy Using a Diabetes Visit Summary and a Patient Tailored Diabetes Self-Management Plan

Abstract

Problem: Over 29 million Americans live with diabetes. Eighty-six million are pre-diabetic, and 90% to 95% of newly diagnosed diabetic cases are Type II Diabetes. Even with advancements in medicine, people with diabetes continue to suffer from preventable complications. Literature shows that involving patients with diabetes in the active management of their chronic disease produces better outcomes. While visit summaries have been used in the past to improve care, data combining diabetic visit summaries with patient self-directed goals were inadequate. Project Aim: The purpose of this quality improvement (QI) project was to determine if establishing patient self-directed goals and having readily available diabetic measures with milestones would improve the patient’s confidence in changing behavior to better improve their diabetes. Project Method: This QI project took place in a primary care clinic. Ten adults age 19 years and older with a diagnosis of Type II Diabetes were recruited from this clinic to participate in the project. Each participant completed a well-validated diabetes tailored Diabetes Empowerment Scale-Short Form (DES-SF) questionnaire before the intervention to assess baseline self-efficacy scores. The participants then received a diabetes visit summary and chose one to two self-directed goals from the diabetes self-management goals that they would like to work on before their next diabetes clinic visit. At the patient three-month diabetic visit, the participants were asked to complete the DES-SF questionnaire again. The outcome of improving self-efficacy scores by establishing patient self-directed goals in this project was measured using DES-SF pre- and post-questionnaire. The Wilcoxon signed rank test was used for statistical analysis. Results: The Wilcoxon Signed Ranks Test showed that six of the participants had positive ranks meaning their post-questionnaire self efficacy scores were higher than their pre-questionnaire scores. Two participants had negative ranks meaning that their post-questionnaire self efficacy scores were less than their pre-questionnaire scores, and two participants had self efficacy post-questionnaire scores equal to their pre-questionnaire scores. Conclusions: This project demonstrated that implementing a diabetes visit summary with patient-tailored self-management goals can improve self-efficacy with a statistical significance of Z = -2.10, p = .04