Date of Award

Spring 6-7-2024

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Bomin Shim

Faculty Reader

Carrie Fry

Executive Summary

Executive Summary

Background and Significance: Cardiovascular disease is the leading cause of death in the Unites States (CDC, 2022). People with diabetes experience a higher rate of cardiovascular disease morbidity and mortality compared to people without diabetes and Native Americans have the highest prevalence of diabetes (14.9%) among any ethnic group in the United States (ADA, 2022b; Li et al., 2021). Native Americans also have a high rate of other cardiovascular risk factors, including obesity, hypertension, smoking, and alcohol use (OMH, 2021). Cardiovascular disease events and mortality can be greatly reduced with early recognition and treatment with lipid lowering therapies (Masson et al., 2019). The lipid profile is used to screen for cardiovascular disease risk, guide lipid lowering treatment, and measure effectiveness of treatment plans (Vijan, 2021). Annual lipid profile screens may improve outcomes in Native Americans with diabetes.

Problem and Purpose Statement: In 2021, the clinic where the intervention took place identified low rates of lipid profile screening among Native American patients with diabetes. The clinic serves 104 Native American patients with diabetes. Of these patients, 32 patients had not completed a lipid profile screen within the last year. Because of their additional cardiovascular disease risk factors, all Native Americans with diabetes may benefit if they complete a lipid profile screen annually. The short-term goal of this project was to create and implement a multi-modal patient outreach toolkit. This toolkit created a systematic approach to patient outreach with the goal of ultimately improving patient outcomes by increasing lipid screening rates and reducing cardiovascular disease risk in Native Americans.

Methods: The project took place at a rural wellness center primarily serving Native Americans from 3/1/2023 – 6/1/2023. A patient outreach toolkit was created and included outreach directions, a list of patients to contact, a telephone call script, a notification letter packet, and a lipid profile brochure. Five nurses from the clinic were recruited to use the toolkit to contact the 32 Native American patients and ask them to complete a lipid profile screen. The toolkit asked the nurses to first contact patients with a phone call, then a week later call a second time and send a letter if the patients did not answer the first phone call, and hand out lipid profile brochures when patients came into the clinic. The data collected included number of patients who made appointments for a lipid profile screen, and the number of patients who completed a lipid profile screen, the number of patients called, the number of second phone calls, the number of letter packets sent, and the number of brochures handed out.

Results: Of the 104 Native Americans served by the clinic, the number who completed a lipid profile screen increased from 72 patients to 88 patients. This demonstrated a 16% increase. Of the 32 patients targeted during the three month project period, 50% completed a lipid profile screen. 18 patients made appointments, and 16 patients completed a lipid profile screen. The nurses called 31 patients, made 17 second calls, and sent two letters. No lipid profile brochures were handed out. The nurses sent only two letters and did not utilize the lipid brochure. Even though the number of patients who completed lipid profile screening increased, phone calls account for the majority of patient-outreach. It is unclear if the improvement in screening rates can be attributed to the use of the toolkit.

Sustainability: Use of the complete patient-outreach toolkit is unlikely to be sustainable. Phone calls was a successful method of patient-outreach and the clinic intends to continue to call patients to notify them they are due for a lipid profile screen. The clinic will not use the mailed letters or lipid brochures. Project materials including instructions, phone scripts, and brochure were given to the clinic to use for future out-reach. Dissemination of the results of the quality improvement project to the community may influence sustainability of patient-outreach.

Implications for Practice: The results of the project indicate patient-outreach in the form of phone calls may increase lipid profile screening rates. Effectiveness of the mailed letter and lipid brochure are undetermined because they were not used during implementation of the project. A larger scale project with a longer timeline is needed to conclusively establish the benefit of patient-outreach in increasing lipid profile screening rates. After completion of the project the nurses identified a need for standing orders for annual lipid profile screening, suggesting involvement of primary care providers in project planning may be helpful for future project.


ADA. (2022a). Standards of Medical Care in Diabetes - 2022 Abridged for Primary Care Providers [Guideline]. American Diabetes Association.

ADA. (2022b, July 28). Statistics about diabetes. American Diabetes Association. Retrieved October 12, 2022, from

CDC. (2022, July 15). Heart disease facts. Centers for Disease Control and Prevention. Retrieved October 12, 2022, from

Li, F.-R., Yang, H.-L., Zhou, R., Zheng, J., Chen, G.-C., Zou, M.-C., Wu, X.-X., & Wu, X.-B. (2021). Diabetes duration and glycaemic control as predictors of cardiovascular disease and mortality. Diabetes, Obesity and Metabolism, 23(6), 1361–1368.

Masson, W., Lobo, M., Siniawski, D., Molinero, G., Huerin, M., & Nogueira, J. P. (2019). Impact of lipid-lowering therapy on mortality according to the baseline non-HDL cholesterol level: A meta-analysis. High Blood Pressure & Cardiovascular Prevention, 26(4), 263–272.

OMH. (2021, March 1). American Indians/Alaska Natives. OMH U.S. Department of Health and Human Services Office of Minority Health. Retrieved October 11, 2022, from

Vijan, S. (2021, August 2). Screening for lipid disorders in adults. UpToDate. Retrieved October 13, 2022.

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