Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Jean Dols


Maria Gillespie


Javier Bocanegra


Heart disease is the leading cause of death in the United States and in Texas. Hyperlipidemia is a precursor to cardiovascular disease and is a highly manageable and treatable acute and chronic disease in the outpatient primary care setting. This project is designed to increase clinicians’ adherence to the American College of Cardiology/American Heart Association (2013) and American Diabetes Association (2016) clinical practice guidelines for the prevention of heart disease in 40 to 75 year old adults with type II diabetes through interactive education, an electronic alert, and quality improvement sessions on the treatment and management of cholesterol in a primary care setting. The objectives were to initiate assessment of atherosclerotic cardiovascular disease risk scores, improve diet/exercise counseling, and increase use of statin therapy when applicable. Key activities included interactive meetings, open discussions with staff, resources including the guidelines, and weekly performance emails. The electronic alert was implemented as a reminder to assess the target group. Three outcomes were analyzed. Atherosclerotic Cardiovascular Disease risk score assessment increased from 0% to 76.7%, diet and exercise counseling documentation increased from 85% to 100%, and statin therapy application increased from 55.1% to 72.2% in eligible adults 40 to 75 years old with type II diabetes. The interventions were successful in improving clinician adherence to the clinical practice guidelines. This initiative helps to build the body of evidence regarding useful interventions to improve primary prevention of heart disease by improving provider adherence to the clinical care guidelines for 40 to 75 year old adults with type II diabetes.