Quality Improvement Initiative Evaluation Essay

Quality Improvement Initiative Evaluation Essay

Quality improvement initiatives help ensure sustained quality outcomes in the healthcare facility. It is a continuous, cyclic process that requires continuous evaluation of processes and care interventions to determine their effectiveness and the need for change. The quality improvement process considers improvement areas and uses evidence-based strategies to ensure quality delivery. Federal agencies such as the agency for healthcare research and quality outline the specific quality indicators for diseases, populations, and categories. These metrics help drive improvement and help asses if QI initiatives are achieving the objectives they were created to achieve. Analyzing these quality initiatives ensures they remain relevant and valuable and minimizes the wastage of resources such as them and money wasted on non-performing projects. This essay examines a QI and proposes additional indicators for its improvement.

QI In the Healthcare Facility

In the healthcare facility, the hospital has a healthcare education program based on the agency for healthcare research and quality that focuses on improving patient self-care and quality outcomes. The program incorporates diabetes self-management education in all diabetes and diabetes Type one patients. The education focuses on all components of the DSME as instructed by the AHRQ. These components include education on the disease process and its complications, management interventions and options, support, access to information, and referral (Davis et al., 2022). The quality initiative in the healthcare facility focuses on ensuring that patients receive adequate diabetes education and support to help improve their care outcomes. The QIs implementation was prompted by the low diabetes patient follow-up turn-up and a rising number of diabetes complications such as diabetic foot, renal injury, and hypertension.

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Additionally, there was poor adherence to diabetes medications and miscommunication between care providers and patients, hence a higher mortality rate related to diabetes. These problems in diabetes care provoked the development of interventions to increase patient management and monitoring and patient-care provider collaboration in care delivery. DSME is an evidence-based strategy that could help improve care delivery by ensuring collaboration between patients and their families and all healthcare providers in healthcare facilities (Ernawati et al., 2021). This quality initiative filed to identify the specific healthcare professionals responsible for the specific interventions, leading to role avoidance. The problem led to role differentiation, with each professional team assigned specific components to address with the patients, such as the pharmacists educating patients on the medications and treatment options.

The objectives of the diabetes self-management education program were to improve the quality of life among diabetes patients, increase the rate of follow-up and collaboration with healthcare providers, improve glycemic control, and reduce complications (Bekele et al., 2021). These are the basis for the evaluation of the project. Bekele et al. (2021), while citing American Diabetes Association, notes that the glycemic metric set for HBbA1c is 7. In the past year, the institutional average was 8.1, a leap from 8.5 in the previous year, showing significant improvement in glycemic control. However, more effort is required to ensure the average is below 7.

Individuals with an average HbA1C test result of above 7 are at increased risk for complications because the results mean that their glucose levels are out of control. The quality-of-life scores were evaluated using various tools such as the Brief Symptom Inventory (BSI), Experience of Treatment Benefits and Barriers (ETBB), and Diabetes Health Profile (DHP) (Andrich & Fornoda, 2020). Result from the past year also showed improved quality of life, with the best-performing areas being psychological distress, self-care ability, and barriers to activity. The agency for healthcare research and quality states that patient satisfaction scores and self-reported healthcare experiences are vital to determining the quality of care delivered (Chen et al., 2019). In the past year, the number of patients who came for diabetic eye and foot exams increased from 45% to 63% and 43% to 66%, respectively.

The biannual HbA1c tests also increased from 26% to 68%. The changes in a follow-up show a leap toward the achievement of the nationally set metrics. According to the National Health Disparities and Quality Report 2021, healthcare facilities should ensure that at least 74% of their patients attend an annual eye exam, 79.5% attend a biannual HbA1c test, and 84 attend an annual diabetic foot exam (AHRQ, n.d.). The assumptions are that all diabetic patients who attended the healthcare facility were recorded and the data used in the quality improvement data analysis. DSME increases care collaboration and patient participation in care delivery. These, in turn, improve their outcomes, including glycemic control and increased follow-up interventions. Measuring these metrics assumes that the DSME is effective and produces the outcomes for which it was developed.

There are standards set forth by the American Diabetes Association that every institution must meet before implementing it to ensure full benefit. These include establishing its recognition as a QI and support, stakeholders’ involvement, and target population needs assessment and resource identification. Other components are well-defined leaders overseeing the team, instructor availability, a written curriculum, individualized assessment results, an education plan, a personalized follow-up plan, and periodic plan evaluation (Davis et al., 2022). The DSME implemented follows these standards strictly and ensure that every standard is duly met and implemented to reap the full benefit of DSME. According to the ADA, these standards help maximize DSME benefits, citing that it is effective when well-implemented but costly and infective when poorly implemented (Davis et al., 2022).

Interprofessional Perspectives and Actions

Interprofessional actions are integral to the success of the quality initiative. Interprofessional collaboration in the QI is integral. The QI has various aspects besides patient collaboration, including community follow-up and the development of healthcare systems supporting its implementation and assessment. Healthcare professionals such as nurses, pharmacists, doctors, and nutritionists also collaborate to develop interventions (such as effective nutritional interventions or effective medications). Collaboration and knowledge in the components of DSME are thus integral to the implementation and success of the QI.

The care professionals must also possess knowledge of DSME to implement it and produce the desired outcomes. Unlike routine education, DSME is complex and requires care professionals to carefully consider their practice and engage the patient fully in all stages of care delivery. Thus, their knowledge enhancement through training, workshops, and continuing education programs focusing on DSME ensures their practices are top-notch and achieve the desired outcomes (Iregbu Et al., 2023). Ensuring compliance with the education standards is also integral due to the high workload the care providers are exposed to

Collaboration also goes beyond healthcare professionals. Planning for collaboration with other professionals in communities, religious leaders, and the family also positively impacts outcomes (Octaviana, 2022). Patients’ health affects their holistic needs; thus, considering these needs is integral to achieving them. Leadership roles and support are integral to the QI. It is not clear the professional team responsible for the QI, despite the emphasis on its implementation by the hospital management. All healthcare professionals own the QI, but a specific department, and more so professionals, should be responsible for the quality improvement initiative, which is lacking in this case. It is unclear which department oversees the initiative’s activities, and there is a need to be sure the person is accountable and responsible for the quality improvement initiative.

Recommended Protocols and Outcome Measures

The DSME is halfway evaluated/ monitored in the healthcare facility, and additional measures/indicators are necessary to determine its effectiveness. The measures monitored are the effectiveness of diabetes self-management education and support on glycemic control, quality of life, and follow-up adherence. Indicators to determine the effectiveness of the DSME in preventing complications and mortality are significant. The indicator selected is mortality rate and rates of diabetes complications, and their comparisons are made annually.


The total mortality rate (home and in-hospital rates) in diabetes helps determine the overall effectiveness of interventions in preventing diabetes complications and diabetes deaths. This indicator is significant, and the AHRQ recommends that all hospitals keep a record of mortalities related to diabetes and diabetes complications (Chen et al., 2020). The indicator is helpful to all national and global strategies in objectives preparation and driving efforts as they focus on improving patient outcomes and ensuring patients have quality lives. Chen et al. (2020) note that the type and rates of specific diabetes complications are essential indicators in measuring the effectiveness of the quality improvement initiative. Diabetes complications include stroke, heart disease, hypertension, blindness, and diabetes neuropathies.

The rate of hospitalization and readmission is also a good indicator of the quality of care, referral, and self-care (AHRQ, n.d.). The DSME also effectively prevents hospitalization and readmissions by increasing care interventions’ effectiveness. Predictors of hospitalizations and readmissions include poor patient-care provider relationships, which affect their collaboration in care delivery and patient outcomes (Ida et al., 2019). The AHRQ outlines and recommends indicators showing long-term and short-term complications and their effects on hospitalization (AHRQ, n.d.). According to Ida et al. (2019), hospitalization in diabetes is an integral indicator of marked deviations in diabetes management. It represents an essential gap in the management and monitoring of diabetes outcomes.

Patients must collaborate in care delivery by following instructions on care interventions such as medication adherence, dieting, and exercise to achieve the desired outcomes. The DSME helps patients through all these interventions, from complications prevention to improved quality of life, such as return to premorbid productivity and independence with activities of daily living (Bekele et al., 2021). Deviations from the instructions lead to poor patient outcomes, subsequent hospitalizations, and concurrent hospital readmissions. Thus, patient readmission and hospitalizations are vital indicators of the effectiveness of the DMSE on patient care and patient outcomes.


Quality improvement initiatives in healthcare should be evaluated based on their set objectives and local, state, and federal accreditation measures. DSME is the quality initiative of interest in this case assessment. It has many objectives that form the basis of the program’s effectiveness. Diabetes patients require support and education to improve their care outcomes. Monitoring the program’s effectiveness through measurable outcomes such as patient satisfaction scores, quality of life scores, follow-up adherence, and glycemic adherence is integral. Other measures include complication, hospitalization, and readmission rates which are indirect indicators of the quality of care and the effectiveness of DMSE. Quality initiative analysis helps implement improvement or change interventions which help with continuous organizational improvement and better patient outcomes.


Agency for Healthcare Research and Quality (n.d.). 2021 National Health Disparities and Quality Report. Retrieved February 20, 2023, from https://www.ahrq.gov/research/findings/nhqrdr/nhqdr21/index.html

Agency for Healthcare Research and Quality (n.d.). Effective Health Care Program: Diabetes complications. Retrieved February 20, 2023, from https://effectivehealthcare.ahrq.gov/health-topics/diabetes-complications

Andrich, D., & Foronda, C. (2020). Improving glycemic control and quality of life with diabetes self-management education: A pilot project. The Journal of Continuing Education in Nursing51(3), 119–123. https://doi.org/10.3928/00220124-20200216-06

Bekele, B. B., Negash, S., Bogale, B., Tesfaye, M., Getachew, D., Weldekidan, F., & Balcha, B. (2021). Effect of diabetes self-management education (DSME) on glycated hemoglobin (HbA1c) level among patients with T2DM: Systematic review and meta-analysis of randomized controlled trials. Diabetes & Metabolic Syndrome: Clinical Research & Reviews15(1), 177-185. https://doi.org/10.1016/j.dsx.2020.12.030

Chen, L., Islam, R. M., Wang, J., Hird, T. R., Pavkov, M. E., Gregg, E. W., Salim, A., Tabesh, M., Koye, D. N., Harding, J. L., Sacre, J. W., Barr, E. L. M., Magliano, D. J., & Shaw, J. E. (2020). A systematic review of trends in all-cause mortality among people with diabetes. Diabetologia63, 1718-1735. https://doi.org/10.1007/s00125-020-05199-0

Chen, Q., Beal, E. W., Okunrintemi, V., Cerier, E., Paredes, A., Sun, S., Olsen, G., & Pawlik, T. M. (2019). The association between patient satisfaction and patient-reported health outcomes. Journal of Patient Experience6(3), 201–209. https://doi.org/10.1177/2374373518795414

Davis, J., Fischl, A. H., Beck, J., Browning, L., Carter, A., Condon, J. E., Dennison, M., Francis, T., Hughes, P. J., Jaime, S., Lau, H. K., McArthur, T., McAvoy, K., Magee, M., Newby, O., Ponder, S. W., Quraishi, U., Rawlings, K., Socke, J., and Villalobos, S. (2022). 2022 National standards for diabetes self-management education and support. The Science Of Diabetes Self-Management And Care48(1), 44–59.https://doi.org/10.2337/dc21-2396

Ida, S., Kaneko, R., Imataka, K., & Murata, K. (2019). Relationship between frailty and mortality, hospitalization, and cardiovascular diseases in diabetes: a systematic review and meta-analysis. Cardiovascular Diabetology18(1), 1-13. https://doi.org/10.1186/s12933-019-0885-2

Iregbu, S., Spiers, J., Duggleby, W., Salami, B., & Schick-Makaroff, K. (2023). Nigerian Health Care Providers and Diabetes Self-Management Support: Their Perspectives and Practices. Qualitative Health Research33(1-2), 92-105. https://doi.org/10.1177/10497323221143889

Oktaviana, D. (2022). The effectiveness of Diabetes Self-Management Education (DSME) Website-Based on Diet Behavior in Type 2 Diabetes Mellitus Patients During the Covid-19 Pandemic In Takalar Regency. International Journal of Nursing and Health Services (IJNHS)5(6), 486-491. https://doi.org/10.35654/ijnhs.v5i6.647



Prepare an evaluation (5-7 pages) of an existing QI initiative to determine if the initiative is effective.


Too often, discussions about quality health care, care costs, and outcome measures take place in isolation—various groups talking among themselves about results and enhancements. Nurses are critical to the delivery of high-quality, efficient health care. As a result, they must develop their skills in reviewing and evaluating performance reports. They also need to be able to communicate outcome measures related to quality initiatives effectively. Patient safety and positive institutional health care outcomes mandate collaboration among nursing staff members to ensure the integration of their perspectives in all quality care initiatives.


In the first assessment, you analyzed an adverse event or a near miss, and outlined a QI initiative to address it. This assessment will give you practice and the confidence to evaluate a quality care initiative in much the same way you might in your health care setting to help determine if the initiative is effective.

Too often, discussions about quality health care, care costs, and outcome measures take place in isolation—each group talking among themselves about results and enhancements. Because nurses are critical to the delivery of high-quality, efficient health care, it is essential that they develop the proficiency to review, evaluate performance reports, and be able to effectively communicate outcome measures related to quality initiatives. The nursing staff’s perspective and the need to collaborate on quality care initiatives are fundamental to patient safety and positive institutional health care outcomes.


Imagine you have been asked to prepare and deliver an analysis of an existing QI initiative at your workplace. The QI initiative you choose to analyze should be related to a specific disease, condition, or public health issue of personal or professional interest to you, or you may use the hospice information provided in the Vila Health: Data Analysis activity in this assessment. The purpose of the report is to assess whether the specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Your target audience is nurses and other health professionals with specializations or interest in your chosen condition, disease, or public health issue.

In your report, you will:

Analyze a current QI initiative in a health care setting.

Identify what prompted implementation of the QI initiative.

Evaluate problems that arose during the initiative or problems that were not addressed.

Evaluate the success of a current QI initiative through recognized benchmarks and outcome measures as required to meet national, state, or accreditation requirements.

Identify the core performance measurements related to successful treatment or management of the condition.

Evaluate the impact of the quality indicators on the health care facility.

Incorporate interprofessional perspectives related to the success of actions used in the QI initiative as they relate to functionality and outcomes.

Recommend additional indicators and protocols to improve and expand outcomes of a current quality initiative.

Ensure your analysis conveys purpose, in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.

Be sure to address all of the bullet points. You may also want to read the Quality Improvement Initiative Evaluation Scoring Guide to better understand the performance levels that relate to each grading criterion. Additionally, be sure to review the Guiding Questions: Quality Improvement Initiative Evaluation [DOCX] document for additional clarification about things to consider when creating your assessment.

Additional Requirements

Your assessment should also meet the following requirements:

Length of submission: A minimum of five but no more than seven double-spaced, typed pages, not including the title page and References section.

Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your evaluation, recommendations, and plans. Current source material is defined as no older than five years unless it is a seminal work. Review the Nursing Master’s Program (MSN) Library Guide for guidance.

APA formatting: Resources and citations are formatted according to current APA style. Review the Evidence and APA section of the Writing Center for guidance.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

Competency 2: Plan quality improvement initiatives in response to routine data surveillance.

Recommend additional indicators and protocols to improve and expand outcomes of a quality initiative.

Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.

Analyze a current quality improvement initiative in a health care setting.

Evaluate the success of a current quality improvement initiative through recognized benchmarks and outcome measures as required to meet national, state, or accreditation requirements.

Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work life quality.

Incorporate interprofessional perspectives related to the success of actions utilized in a quality improvement initiative as they relate to functionality and outcomes.

Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.

Convey purpose, in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly writing standards.




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