NU813 Unit 7 Midpoint Data Report Example

Eight Points Are Not Yet a Chart: A Midpoint Data Report on Standing-Order Diabetic Foot Exams After Eight Weeks at a Composite Community Health Center, Three Denominators and a Rolling Rate That Moved Seven Points

[Student Name]

Purdue University Global

NU813: DNP Project Implementation

Unit 7 Midpoint Data Report

[Instructor Name]

[Date]

The health center, its registry and every figure are composite; counts, weeks and percentages are bracketed and computed consistently.

Purpose of the Report

This report covers project weeks [3] through [10]: eight weeks of standing-order foot exams at the main clinic and five at the satellite, which launched in [week 6] once its equipment arrived. It answers three questions set in the evaluation plan for the midpoint. Is the exam being delivered to eligible patients at the rate the fidelity plan requires? Is it being delivered completely? And is the health center's rolling twelve-month foot exam rate moving in the expected direction? It does not ask whether foot outcomes have changed. Ulcers and amputations are rare events on a time scale of years, and eight weeks cannot speak to them. Implementation outcomes such as fidelity and penetration are measured early precisely because they can be observed long before patient outcomes can (Proctor et al., 2011).

Data Sources

Three sources were used, all exported on the Monday after [week 10]. The first is the diabetes registry, which lists each adult with a diabetes diagnosis, the date of the last documented foot exam and the source of that exam: the new flowsheet, a provider note or an outside podiatry report scanned into the chart. The second is the flowsheet extract, one row per completed or deferred exam, with visit date, visit type, clinic, the elements completed and the risk category assigned by the provider. The third is the referral log kept by the referral coordinator, listing each podiatry referral, the date placed and the date of the first podiatry visit if one has occurred.

Cleaning, Counted

The registry export held [2,412] rows. Merging [9] duplicate patients, registered twice under name variants, and excluding [57] patients who had transferred care or died left [2,346] adults. The baseline rate was recalculated on this cleaned registry and remains [54] percent, the same as the figure in the proposal after rounding. The flowsheet extract held [376] completed exams. [Nine] were second exams on patients examined earlier in free text during the float-profile problem described in the barrier analysis; those patients were counted once, leaving [367] unique patients examined. The extract also held [23] recorded deferrals. Patient names and record numbers were replaced with study numbers before any table was built, and the key linking the two is held by the clinic manager.

Three Denominators

The protocol deviation memo committed the project to reporting coverage three ways after the medical director widened eligibility in [week 5], and this report keeps that promise.

1. Protocol coverage, main clinic, weeks 3 to 10: [263] exams at [322] scheduled diabetes follow-up visits by patients with an open care gap, [82] percent. This is the figure the fidelity threshold of [75] percent applies to.

2. Expanded coverage, weeks 5 to 10: [251] exams at [349] eligible visits of any type at the main clinic, [72] percent; at the satellite, weeks 6 to 10, [61] exams at [104] eligible visits, [59] percent.

3. Unique patients examined, both clinics, weeks 3 to 10: [367], about [16] percent of the cleaned registry.

More patients were examined under the wider rule and its percentage is lower, which is exactly what the deviation memo predicted when visits were added faster than exams.

The weeks 3 to 6 figures include the [41] exams recovered from free-text notes and entered into the flowsheet in [week 6]. Without them, protocol coverage for those weeks would read [62] percent instead of [77], and the report shows both versions in the appendix tables so the correction is visible.

Weekly Protocol Coverage at the Main Clinic

The weekly proportions were [67.6], [75.0], [82.9], [82.5], [84.6], [85.4], [85.7] and [88.1] percent for weeks 3 through 10. Their median is [83.8]. The figures are plotted as a run chart with that median drawn across it.

The evaluation plan set a minimum of [ten] data points before run chart rules would be applied, following published guidance that rules for shifts, trends and runs depend on having enough points to separate signal from chance (Perla et al., 2011). Eight points do not meet that minimum, and the chart is therefore described, not judged. The last five points happen to rise in sequence, which would satisfy a common trend rule on a longer chart. Reporting that as a trend now would apply a rule the project agreed not to use until week [12], and it would invite the conclusion that coverage is still climbing when the change from [85.7] to [88.1] could easily be noise from a week with [42] visits.

The satellite has five weekly points, [70], [71], [43], [50] and [59] percent. The dip in weeks 8 and 9 follows the resignation of its only trained medical assistant at the end of [week 7], discussed in the Unit 5 seminar, after which the nurse practitioner performed the monofilament test while the new assistant did the inspection. Five points with a known staffing event in the middle are reported as context only.

Completeness of Each Exam

Content adherence, the share of completed exams with every required element recorded, was [84] percent in weeks 3 to 6 and [91] percent in weeks 7 to 10, above the [90] percent threshold for the first time. The element most often missing early was vibration testing; after the nurse educator reviewed it at huddle in [week 6], it was missing on [4] percent of exams. The educator observed [46] exams across both clinics in the period and judged monofilament technique correct in [43].

The Rolling Rate, and Why It Moves Slowly

The health center's rolling twelve-month rate, the measure its payers and quality committee watch, moved from [54] percent to [61] percent. The arithmetic explains why that is both encouraging and modest. Each patient with an open gap who is examined adds one patient in [2,346], about [0.04] percentage points. At the same time, patients whose last exam passes the twelve-month mark leave the numerator. Over eight weeks about [243] patients crossed that line, more than a steady year would produce, because last year's outreach campaign bunched many exams into these same months. Adding the [367] in-clinic exams and [44] outside reports and subtracting the [243] expirations gives a net gain of [168] patients, which, divided by [2,346], gives the [7] points observed.

The rise has more than one source. Of the [367] in-clinic exams, [311] were completed by medical assistants under the standing order and [56] by providers using the same flowsheet. The [44] outside podiatry reports scanned into charts in the same weeks rose after the health center's quarterly care-gap outreach calls in [week 8]. The rate therefore cannot be credited to the project alone, and this report counts each source separately.

Referral Follow-Up

Providers classified [31] examined patients as high risk under the international foot group's categories (Schaper et al., 2024). Referrals to the partner podiatry practice were placed for [26]; [5] already see a podiatrist. Of the [14] referrals that have reached the [30]-day mark, [8] patients were seen within [30] days, [57] percent, well below the [80] percent target in the evaluation plan. This is the weakest component at the midpoint, and it is flagged for discussion in the troubleshooting seminar rather than explained away here.

Balancing Measures

Median rooming time rose by [3.5] minutes at scheduled diabetes visits and [4.0] minutes at acute visits, inside the [five]-minute review trigger set in the deviation memo. [Twenty-three] deferrals were recorded, [19] of them at acute visits, most often for patients who were vomiting, in significant pain or unable to remove footwear because of swelling.

What the Midpoint Supports

The data support three statements. The exam is reaching eligible patients at the main clinic above the fidelity threshold. Exams are now complete at the required rate. And the rolling rate is rising, with in-clinic exams as one source among several. They do not support statements about foot outcomes, about a trend in weekly coverage, or about the satellite, whose short series is interrupted by a staffing gap. Guidance for reporting improvement work asks that results be presented with the context needed to interpret them and without overstatement (Ogrinc et al., 2016), and this report is written to that standard.

Appendix: Analysis Steps

The analysis was run in Python with the pandas and matplotlib libraries; the commented script is attached so a second person can reproduce every figure. Its steps are:

1. Read the three exports and replace record numbers with study numbers from the key.

2. Merge duplicate registry rows and drop patients flagged as transferred or deceased, writing the counts to a log.

3. Join flowsheet rows to registry rows, mark second exams on the same patient and count unique patients.

4. Label each eligible visit as protocol-eligible, expanded-eligible or both, by visit type and date.

5. Count exams and eligible visits by week, clinic and rule, and compute the three coverage figures.

6. Recompute the rolling twelve-month rate weekly from exam dates, separating flowsheet, provider-note and outside sources.

7. Plot weekly protocol coverage with its median and save the chart and tables to the report folder.

References

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7

Schaper, N. C., van Netten, J. J., Apelqvist, J., Bus, S. A., Fitridge, R., Game, F., Monteiro-Soares, M., Senneville, E., & IWGDF Editorial Board. (2024). Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews, 40(3), Article e3657. https://doi.org/10.1002/dmrr.3657