Date of Award

Fall 2022

Project Type

Clinical Doctorate

College or School




Program or Major

Doctor of Nursing Practice (DNP)

First Advisor

Hyunouk Hong

Second Advisor

Lauryn Frost

Third Advisor

Cathleen Colleran


Background: The rising incidence of diabetes within the United States and worldwide has led to increased diabetes related morbidity and mortality. As the leading cause of end stage renal disease (ESRD), more attention needs to be placed on increasing rates of diabetic nephropathy screening. The vast majority of diabetics are treated in primary care, positioning primary care as a center focus for diabetes related screening and treatment.

Local problem: Low rates of diabetic nephropathy screening were noted at an academic medical center affiliated primary care clinic. A quality improvement initiative was elicited to increase the number of urine microalbumin creatine ratio tests ordered by primary care providers.

Methods: Using the Plan-Do-Study-Act (PDSA) framework, a pre-visit planning intervention aimed at reducing missed opportunities during primary care visits was enacted over a 2 month period. The specific aim of this quality improvement initiative was to increase the number of ordered uACR screening tests in patients with type 1 and type 2 between the ages 18 and 75 who had not had a test completed within the past year.

Interventions: A report was generated the day prior to scheduled visit encounters for those diabetic patients overdue for a diabetic nephropathy screening. uACR orders were queued and pended for provider signature within the upcoming visit encounter. The pending order flagged the medical assistant (MA) to prepare a specimen cup. The provider handed the patient the specimen cup at the conclusion of the visit for the urine to be collected.

Results: Of the 91 diabetic patients seen during the intervention, 87 patients had an order for a uACR signed during the visit encounter. This demonstrates an order compliance rate of 95.6%, an improvement by 26.7 percentage points when compared to the to the pre-intervention data.

Conclusions: This quality improvement initiative underscored the importance of avoiding missed opportunities and taking advantage of all patient contact to perform diabetes follow up as a team. The increased number of signed uACR orders during the intervention brings to light the potential advantages of a pre-charting to avoid missing vital recommended screening tests.