Date of Paper/Work

12-2010

Type of Paper/Work

Systems Change Project

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Gay M Varecka

Abstract

This quantitative, non-experimental, retrospective chart review investigated the possible presence of clinician driven disparities in the care of Black/African American patients with diabetes at an urban clinic. The study was a response to the Institute of Medicine’s call to address patient, system, and clinician issues that negatively impact management of patients with chronic diseases including diabetes. The goal is to improve patient outcomes using system wide care guidelines to increase success at meeting the nationally accepted Diabetes 5 (D5) measures. During a twelve month period, clinician response to elevated low density lipoproteins (LDLs) was assessed while considering patient preferences, side effects of medications, economic issues, and patient adherence. Patients were divided into groups with either government or private insurance and by race/ethnicity. The sample consisted of 75 individuals, 41 Caucasian, 19 African Americans, and 15 Eastern Africans. The study used an unvalidated diabetes chart assessment tool developed by the researcher. Information regarding other LDL related comorbidities were tracked including body mass index and hypertension. The study was guided by the social justice theory and Wagner’s Chronic Care Model. Findings of the study did not support clinician driven disparities. However, it was evident there is room for improvement in LDL management of patients in the study regardless of race or socioeconomic status. The research makes several recommendations for systems changes to improve outcomes of diabetes management of all patients at the clinic.

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