Eggenberger, Terry

Missed appointments disrupt care continuity, delay diagnoses, and decrease revenue in primary care settings. This quality improvement project at Meadow Clinic aimed to reduce no-show rates through evidence-based interventions targeting identified barriers such as forgetfulness, scheduling conflicts, and transportation issues. Participants included 72 patients with a history of missed appointments, who were surveyed to identify their preferences and challenges for adhering to office visits. The project used Jean Watson’s Theory of Human Caring and the Plan-Do-Study-Act framework (Appendix A) to guide the design and implementation of interventions: enhanced telehealth integration, personalized multi-modal reminders, and patient education on digital health tools. Quantitative and qualitative data were collected via electronic health records and surveys, analyzed using thematic analysis and descriptive statistics. Findings revealed that text reminders and telehealth significantly improved appointment adherence and patient satisfaction, while flexible scheduling addressed logistical challenges. Post-intervention, the clinic observed reduced no-show rates and increased telehealth usage. These results underscore the value of patient-centered strategies in improving access, operational efficiency, and healthcare equity. This scalable model offers practical implications for enhancing care delivery across diverse healthcare settings.

Quality nursing care has significant impact on patient outcomes. There are many factors that can affect quality nursing care like staffing shortages when the caring demands are high, which can affect patient care. Even though there are existing healthcare policies, evidence-based practices and incentives for healthcare settings who perform and meet the healthcare benchmarks, the United States healthcare performance is poor. The researcher aimed to conduct a study to understand the relationship between patients experience of nurse caring and patients’ readiness to transition from the hospital to home or other care settings. In addition, the predictors among the patients’ characteristics of patients’ readiness to transition from the hospital to home or other care settings were examined too. The research study was grounded in the Quality Caring Model (Duffy, 2018). Descriptive correlational research design was used in the study to examine the relationship between patients experience of nurse caring and patients’ readiness to transition from the hospital to home or other care settings. The study was conducted on one medical-surgical unit in an urban medical center in South Florida during a global pandemic. There were 103 participants who answered the demographic data survey, Caring Assessment Tool-V (CAT-V) and Readiness for Hospital Discharge Scale-Adult Form (RHDS-Adult Form). Descriptive and inferential statistics were conducted using SPSS version 28. Based on data analysis, there was a significant relationship between patients experience of nurse caring and patients’ readiness to transition from the hospital to home or other care settings (p=<.05). Therefore, patients with positive experiences of nurse caring will be more likely to transition from the hospital to home or other care settings. In addition, among the patient characteristics, the marital status could predict patients’ readiness (knowledge, coping ability and expected support subscales) to transition from the hospital to home or other care settings. Therefore, paying attention to the value of support systems of the patients will determine the readiness of the patients to go home or to be discharged to other care settings (p=<.05). The limitations of the study were low generalizability, inability to recruit 135 participants and selection bias (threat to internal validity).

Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States. In 2014 approximately 142,000 individuals in the U.S. died from COPD (Office of Disease Prevention & Health Promotion, Healthy People 2020). The Global Obstructive Lung Disease Initiative (GOLD) (2019) provides evidence-based practice (EBP) guidelines for diagnosing, managing, and treating Chronic Obstructive Pulmonary Disease (COPD). This Doctor of Nursing Practice (DNP) quality improvement project used best practice recommended by GOLD (2019) to improve assessment of COPD by use of the Chronic Obstructive Pulmonary Disease Assessment Test (CAT). The implementation process for using the CAT was guided by a conceptual framework called the Transtheoretical Model (TTM) (Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992) to initiate change. The underlying philosophical foundation for this project was from Nursing as Caring (NAC) envisioned by Boykin and Schoenhofer (1993). The use of the CAT Score recognized the experience of symptoms by COPD patients and then allowed providers to follow GOLD (2019) guidelines and enabled best practice in the management of pharmacotherapy for COPD patients. 174 patients who had a diagnosis of COPD at a pulmonary practice were administered that CAT before an office visit over three months. The use of the CAT for patients with COPD demonstrated that the board-certified pulmonologists at a pulmonary practice adhered to GOLD (2019) guidelines in their plans of care for patients with COPD. Given the CAT measures eight quality of life items related to COPD, the CAT result allowed providers to follow the evidencebased practice (EBP) found in GOLD (2019) and to demonstrate NAC.