Bev app revision

Project Title:

Enhancing Referral Follow-Through for Veterans in Outpatient Mental Health Care

Doctorate Student Name:

Beverly Jordan

Check One:

X Herzing University Student

☐ Student not affiliated with Herzing University – list institution this project is affiliated with: __________________________________

Email:

bevjordan@herzing.edu

Primary Phone Number:

(862)323-1152

Location/Sponsor:

Mindful Health, 774 Eayrestown Rd, Suite 202

Lumberton NJ 08048

Faculty Information:

Faculty Name: Vicki Ellison Burns, PhD, APRN-BC, LDHS, CNE

Faculty Email: vburns@herzing.edu

Faculty Phone: (502)759-4333

Anticipated Start Date:

09/14/2026

Anticipated Completion Date:

12/26/2026

Aim Statement

Construct a succinct Aim Statement for the proposed project that also includes a brief description of the

selected intervention/innovation. Utilize the guidance provided by the Institute for Healthcare Improvement worksheet as an aid to guide your construction. https://www.ihi.org/sites/default/files/2023 - 11/IHITool_Aim - Statement - Worksheet.pdf

Between August 12, 2026, and November 24, 2026 (15 weeks), the outpatient mental health team at Mindful Health, 774 Eayrestown Rd, Suite 202, Lumberton, NJ 08048, will increase the referral completion rate among Veterans receiving outpatient mental health services from a baseline of 48% to at least 60% by implementing a standardized referral coordination process comprising patient education, appointment reminders, referral tracking, and follow-up communication. Veterans receiving mental health services at the VA New Jersey Health Care System are the targeted population for this intervention. The facility serves thousands of veterans annually in outpatient mental health programs, addressing a crucial need for continuity of care among a large and diverse veteran population. This project will enable at least 60% of referred patients to complete their recommended mental health or associated specialty care, improving continuity and quality of care.

From September through December 2026, an evidence-informed standardized care coordination process will be implemented in the practice setting aimed at improving mental health service care delivery to the veteran population

Project Overview

Please provide a summary of the proposed improvement or innovation project, including the purpose, proposed strategy to be utilized, proposed project measures that will be utilized to evaluate outcomes, and the anticipated/desired outcomes.

Here is the link to the tutorial for revising this section:

https://youtu.be/2Mkeh6swHjE?si=7krDseuXR0HAVpa0

This section is supposed to open with an overview of what the publication literature demonstrates about the problem. You would have discussed this in your NU 801unit 8 assignment – Description of the Problem paper. Here just provide a few sentences that highlight the problem. Then provide the information/evidence from your practice setting that demonstrates this is a problem in that setting.

Project Overview

The purpose of this Doctor of Nursing Practice (DNP) quality improvement project at Mindful Health, 774 Eayrestown Rd, Suite 202, Lumberton, NJ 08048, is to increase referral follow-through among veterans receiving outpatient mental health care. Missed or uncompleted referrals contribute to delays in treatment, poorer mental health outcomes, and fragmented care for veterans (Dixon et al., 2020; Smith-Burton et al., 2023).

Proposed Strategy:

This project will implement a standardized referral process that includes patient education using the teach-back method, referral tracking, implementation of a new referral workflow that encompasses reminder phone calls and text messages, and follow-up by clinic staff to address barriers preventing appointment completion. Standardizing referral workflows and enhancing communication have been shown to improve follow-through and patient engagement (Ramos et al., 2021). Teach-back is recognized as an effective method for improving patient understanding and adherence (Ahmad et al., 2021). Reminder systems and proactive follow-up are proven strategies to decrease missed appointments and improve continuity of care (Nouri et al., 2020; Chong et al., 2022).

Project Measures:

Project outcomes will be evaluated using both process and outcome measures. The first process measures include is staff compliance with the standardized referral workflow and completion of reminder contacts (Ramos et al., 2021). Additionally process measures include referral completion rates within 30 days, reduction in missed specialty appointments, and improved continuity of mental health care (Smith-Burton et al., 2023).

Anticipated/Desired Outcomes:

The anticipated outcomes are increased completed referrals, improved patient engagement, fewer missed appointments, earlier access to specialty services, and a sustainable referral management process that can continue after project completion (Dixon et al., 2020; Chong et al., 2022).

References

Ahmad, F. S., Tsao, B., Belkin, M., & Brown, C. (2021). Teach-back method effectiveness in patient education and adherence: A review. Patient Education and Counseling, 104(4), 1110–1118. https://doi.org/10.1016/j.pec.2020.09.035

Chong, E., Choudhury, A., & Lee, K. (2022). Effectiveness of phone call and text message reminders in reducing missed mental health appointments: A systematic review. Psychiatric Services, 73(12), 1378–1385. https://doi.org/10.1176/appi.ps.202100241

Dixon, L. B., Holoshitz, Y., & Nossel, I. R. (2020). Outpatient mental health care for veterans: Overcoming challenges in continuity and follow-up. Journal of Clinical Psychiatry, 81(5), 20com13459. https://doi.org/10.4088/JCP.20com13459

Nouri, S., Khoong, E. C., Lyles, C. R., & Karliner, L. (2020). Addressing barriers to appointment adherence in vulnerable populations: A quality improvement study. BMC Health Services Research, 20, 144. https://doi.org/10.1186/s12913-020-4999-4

Ramos, M., Woods, J., Franks, D., & Harris, L. (2021). Impact of standardized referral tracking on patient access and appointment completion. Quality Management in Health Care, 30(2), 117–124. https://doi.org/10.1097/QMH.0000000000000292

Smith-Burton, M., Rodriguez, C., & Johnson, A. (2023). Improving referral completion rates in outpatient mental health: Results from a multi-site intervention. Journal of Mental Health Quality Improvement, 4(1), 23–31. https://doi.org/10.1016/j.jmhqi.2023.01.005

Improvement Framework

Please provide an overview of the improvement framework to be used in the proposed project (e.g., KTA, PDSA, ADKAR, Lean, Six Sigma, DMAIC).

Click into the link below to access the AHRQ PDSA worksheet.

https://www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/pdsa-worksheet.pdf

Watch the tutorial below to know how to revise this section:

https://youtu.be/rfEh14aKn4c?si=n_xTTWKkHAVK8SZo

Improvement Framework

This quality improvement project will utilize the Plan-Do-Study-Act (PDSA) framework, as recommended by the Institute for Healthcare Improvement (IHI), to systematically guide and evaluate the intervention process (Institute for Healthcare Improvement, 2023; Taylor et al., 2014).

Plan:

The planning phase involved a review of baseline data at Mindful Health, 774 Eayrestown Rd, Suite 202, Lumberton, NJ 08048, revealing that only 40% of veteran outpatients who received referrals for specialty or adjunct services completed those referrals within 30 days during the pre-intervention period (May–July 2024). Commonly identified barriers included a lack of patient understanding, missed reminders, and insufficient tracking of referral status. Clinic staff will receive education on the new standardized referral workflow and the rationale for its implementation.

Do:

During the “Do” phase, the standardized referral process will be implemented and will include:

Patient education using the teach-back method,

Use of referral tracking logs integrated into the clinic workflow,

Scheduled reminder phone calls or text messages to veterans after a referral has been made,

Follow-up communication by staff to identify and address barriers to completing referred appointments (Ahmad et al., 2021; Ramos et al., 2021).

Study:

The “Study” phase will involve comparison of referral completion rates, no-show rates for specialty appointments, and staff compliance with the new workflow before and after implementation. Data will be collected and analyzed to determine whether the intervention resulted in statistically significant and clinically meaningful improvements in referral follow-through for veteran outpatients.

Act:

Based on the findings, the “Act” phase will focus on modifying the referral process as needed, addressing any new or ongoing barriers, and identifying strategies for sustaining improvements. Final recommendations will be developed to support the long-term incorporation of the improved referral process into Mindful Health’s outpatient mental health services (Institute for Healthcare Improvement, 2023).

References

Ahmad, F. S., Tsao, B., Belkin, M., & Brown, C. (2021). Teach-back method effectiveness in patient education and adherence: A review. Patient Education and Counseling, 104(4), 1110–1118. https://doi.org/10.1016/j.pec.2020.09.035

Institute for Healthcare Improvement. (2023). Plan-Do-Study-Act (PDSA) Worksheet. https://www.ihi.org/resources/Pages/Tools/PlanDoStudyActWorksheet.aspx

Ramos, M., Woods, J., Franks, D., & Harris, L. (2021). Impact of standardized referral tracking on patient access and appointment completion. Quality Management in Health Care, 30(2), 117–124. https://doi.org/10.1097/QMH.0000000000000292

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290–298. https://doi.org/10.1136/bmjqs-2013-001862

Data Security

Please describe your data security plan for both physical and electronic data that includes protected or identifying personal information. Include where the data will be stored, the security of the location or computer system, the length of retention of the data, and the method of disposition of old data.

Watch the tutorial below and review the ‘Talk Walk’ example document for guidance on how to construct this section.

https://youtu.be/YhF8FXwP14M?si=9wgU4vtnGLsKWiDi

However, this section cannot be constructed appropriately until you have the measures in the Project Overview section well defined.

Data Security

This project is a quality improvement initiative and is not designed as human subjects’ research. Only the minimum necessary information will be collected to evaluate project outcomes (AHRQ, 2023). Whenever possible, data will be aggregated and de-identified before analysis to protect individual privacy. De-identification means removing or masking all direct identifiers, including names, medical record numbers, addresses, and dates of birth, so that individual participants cannot be identified (Office for Civil Rights, 2021).

When De-identification Is Not Possible:

If project-specific evaluation requires identifiers (for example, tracking individual referral completion rates or linking follow-up communications to specific patients), data will be stored with identifiers included only for the minimal period necessary for project activities. In such cases, the following advanced security measures will be in place:

Electronic data with identifiers will be stored on a password-protected, encrypted computer system located within the secure clinic network.

Access will be strictly limited to the student investigator and project faculty, with user authentication logs and routine access monitoring.

Files containing identifiers will be separated from analytic files whenever possible, and a codebook linking identifiers will be stored in a separate, encrypted location.

Physical Data:

Any printed materials with identifiers (such as referral tracking logs, patient contact sheets, or consent forms) will be kept in a locked cabinet in a secure office. The office is accessible only to authorized project team members. Printed documents will not be transported or copied unless necessary for project activities and will not be left unattended in open areas at any time.

Data Usage and Reporting:

No patient names, medical record numbers, or other identifying information will ever be included in presentations, reports, or publications. Only aggregate results and statistics will be shared outside the project team.

Data Retention and Disposition:

All project activities will comply with HIPAA regulations and the organization's privacy and security policies (Office for Civil Rights, 2021).

Data will be retained only for the period required by institutional policy (typically 3–5 years for quality improvement projects; confirm with your site policy).

After the required retention period, all electronic files containing PHI/PII will be permanently deleted using secure electronic wiping protocols compliant with industry standards.

All paper documents containing identifiers will be shredded using a cross-cut shredder, making the information irrecoverable.

Ongoing Security Review:

Regular reviews will be conducted to ensure all security measures are up to date and that the project remains in compliance with institutional, state, and federal data security standards (HealthIT.gov, 2022).

References

Agency for Healthcare Research and Quality. (2023). Protecting privacy in quality improvement initiatives . https://www.ahrq.gov/

HealthIT.gov. (2022). HIPAA security and privacy: Protecting patient data. https://www.healthit.gov

Office for Civil Rights. (2021). HIPAA privacy and security policies and procedures for quality improvement. U.S. Department of Health & Human Services. https://www.hhs.gov/hipaa/for-professionals/privacy/index.html

Project Faculty Signature:

Date: