Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Dianne Lavin DNP, PsyD, RN, PHNP-BC, MPH


Miranda Williams MSN, FNP-BC


Despite the proven benefits of diabetes self-management education (DSME), referral and attendance remains suboptimal. DSME has the ability to encourage self-care behavior, improve clinical outcomes, and improve quality of life in a cost-effective manner. The American Diabetes Association recommends that all people with diabetes receive DSME in order to facilitate the knowledge, skills, and ability necessary for diabetic self-care. The Office of Disease Prevention and Health Promotion, Healthy People 2020, set a national diabetic patient education attendance target goal of 62.5% for adults. The purpose of this quality improvement project is to increase referral and attendance to DSME in type-2 diabetic patients. Interventions included: electronic medical record modifications, educating staff on ADA recommendations/Healthy People 2020 target goals, providing information material about DSME to patients, and scheduling diabetes self-management education appointments. The project was conducted at a Northwest San Antonio family practice clinic where baseline DSME referral rate was 5.8% and baseline DSME attendance rate was 1.5%. Two-hundred eligible patient electronic medical records were retrospectively reviewed in order to determine referral and attendance rates pre-/post-intervention. Interventions took place between June 1 to July 31, 2017. Post-intervention, the average referral rate increased to 31% and the average attendance rate increased to 11%. An independent sample t-test found that interventions were statistically significant for referrals; but not statistically significant for attendance.