De la Cerda, Jodie

Aims: The aim of this quality improvement project is to improve the quality of care for those with uncontrolled type II diabetes at the primary care facility (Palm Beach Family Medical Associates). The current standard of care of following up every 3 months is deficient in controlling HgbA1c. Literature and caring science supports an intervention with education and self-efficacy as the focus. Method: Apply evidence-based intervention of a diabetes education program with focus on self-efficacy and following up every two weeks on nutrition, exercise, weight management, and medical management. Participants are 45 years or older with uncontrolled Type II Diabetes with HgbA1c > 7.0. HgbA1c and Diabetes Management Self-Efficacy Scale is measured pre and post intervention and follow ups are completed over telephone calls.
Results: There was a significant (p < 0.05) decrease in both HgbA1c and DMSES values after intervention was completed.
Conclusion: Administering a diabetes education program with emphasis on self-efficacy and repetition through biweekly follow-up shows potential for improving HgbA1c and DMSES scores for those with uncontrolled diabetes (HgbA1c > 7.0). Many limitations are noted including loss of 40% of participants over time and application of program for only 3 months. Despite limitations, this quality improvement intervention shows promise in improving care for those with Type II diabetes.

The purpose of this quality improvement initiative was to improve sleep quality and reduce insomnia severity in individuals diagnosed with insomnia. This project was completed with 11 total participants, in which smartphone-delivered cognitive behavioral therapy for insomnia (i.e., CBT-I Coach) was utilized four or more days out of the week. The project spanned the course of six weeks. Insomnia severity was measured using the Insomnia Severity Index (ISI) and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). The General Self- Efficacy Scale (GSE) was also utilized to evaluate participants general self-efficacy. Questionnaires were administered pre and post intervention. Additionally, a self-developed CBT-I utilization questionnaire was administered at weekly check-ins. The results yielded a mean decrease of 57% for PSQI scores and 50% for ISI scores, as well as a mean increase of 17% on GSE scores. The results confirm that smartphone delivered CBT-I is a beneficial tool in improving sleep outcomes for individuals suffering from insomnia. Mobile CBT-I has significant implications for enhancing patient care and evolving current healthcare practices, particularly for the treatment of insomnia.