Capstone Change Project Implementation Plan

Criteria

Article 1

Article 2

Article 3

Article 4

APA Reference

All peer reviewed journal articles should be current (published within the last 5 years) and closely relate to the PICOT question developed earlier in this course. Include the GCU permalink or working link used to access the article.

Shao, Y., Shi, L., Nauman, E., Price‐Haywood, E. G., & Stoecker, C. (2023). Telehealth use and its impact on clinical outcomes in patients with type 2 diabetes during the COVID‐19 pandemic. Diabetes, Obesity and Metabolism. https://doi.org/10.1111/dom.15293

Ballesta, S., Chillarón, J., Inglada, Y., Climent, E., Llauradó, G., Pedro‐Botet, J., Cots, F., Camell, H., Flores, J. A., & Benaiges, D. (2023). Telehealth model versus in-person standard care for persons with type 1 diabetes treated with multiple daily injections: an open-label randomized controlled trial. Frontiers in Endocrinology, 14. https://doi.org/10.3389/fendo.2023.1176765

Chiaranai, C., Chularee, S., Saokaew, S., Bhatarasakoon, P., Umnuaypornlert, A., Chaomuang, N., Doommai, N., & Nimkuntod, P. (2024). Effectiveness of telehealth on the glycemic control of patients with type 2 diabetes mellitus during the COVID-19 pandemic: A systematic review and meta-analysis of randomised controlled trials. International Journal of Nursing Studies Advances, 6, 100169. https://doi.org/10.1016/j.ijnsa.2023.100169

Dat, T. V., Binh, V., Hoang, T. M., Tu, V. L., Luyen, P. D., & Thi, L. (2024). The effectiveness of telemedicine in the management of type 2 diabetes: A systematic review. SAGE Open Medicine, 12. https://doi.org/10.1177/20503121241271846

Purpose/Aim of Study

To evaluate the impact of telehealth use during the COVID-19 pandemic on glycemic control and other clinical outcomes among patients with type 2 diabetes.

The study aimed to compare the effectiveness of telehealth (TH) versus standard in-person care in managing type 1 diabetes (T1D) by evaluating changes in glycated hemoglobin (HbA1c) over six months.

To assess the effectiveness of telehealth in improving glycemic control in patients with type 2 diabetes during the COVID-19 pandemic.

The study aimed to evaluate the effectiveness of telemedicine in managing type 2 diabetes through a systematic review.

Research questions (Qualitative)/Hypothesis (Quantitative)

Hypothesis: Telehealth use improves glycemic control and clinical outcomes compared to in-person care.

Hypothesis: Telehealth would be noninferior to in-person care regarding HbA1c changes while offering improved accessibility and reduced costs.

Hypothesis: Telehealth interventions improve glycemic control and related health metrics more effectively than standard care.

Hypothesis: Telemedicine improves glycemic control in patients with type 2 diabetes compared to conventional care.

Design

Type of quantitative or type of qualitative study design

Quasi-experimental difference-in-difference design with propensity-score weighting.

Randomized controlled trial (RCT) with open-label and parallel-arm design.

Quantitative systematic review and meta-analysis of randomized controlled trials.

Qualitative systematic review of studies

Setting

Where did the study take place? What type of setting – inpatient, outpatient, etc.?

Outpatient care settings using data from the REACHnet database across three Louisiana health systems.

The study took place in an outpatient setting at Hospital Comarcal de l’Alt Penedès, targeting adults in rural areas.

No specific physical location as data were sourced from multiple trials.

No specific physical location as data were sourced from multiple trials.

Sample

Number and characteristics of participants

Includes adult patients (aged 35+) with type 2 diabetes (N=total not specified).

Fifty-five adults with T1D using multiple daily insulin injections participated. Inclusion criteria required internet access and familiarity with the SocialDiabetes® app.

Twelve trials, 1,498 participants, primarily adults with type 2 diabetes.

134 studies involving diverse adult populations with type 2 diabetes.

Methods

Interventions/Instruments

Telehealth users were compared to non-users through electronic health records, with outcomes measured using HbA1c, LDL cholesterol, BMI, and blood pressure.

Participants received either standard in-person care or teleconsultations combined with fewer in-person visits. Data were collected via the SocialDiabetes® app and clinical evaluations.

Telehealth interventions such as remote monitoring, consultations, and educational support were analyzed using a random-effects model.

Interventions included teleconsultations, telemonitoring, and tele-education, analyzed via glycemic index improvements.

Analysis

How were the data that were collected analyzed?

Propensity-score-weighted linear regression and difference-in-difference models were used to assess outcome differences pre- and post-intervention.

Mixed-effects models were employed to evaluate differences in HbA1c changes, alongside parametric and nonparametric tests for other outcomes.

Data were analyzed using a random-effects model, and outcomes were assessed for heterogeneity using I² and Cochran's Q tests.

Data were extracted and assessed for quality using NIH Study Quality Assessment Tools.

Outcomes/key findings of the study and implications for nursing practice (Summary of study results)

Telehealth users showed significant reductions in HbA1c (average decrease of 0.146%) and modest improvements in LDL, BP, and BMI.

The study found no significant differences in HbA1c between groups but observed improved glucose metrics and quality of life with telehealth. TH reduced patient costs and time, highlighting its potential in rural healthcare delivery.

Telehealth interventions reduced HbA1C levels (-0.59, p < .001) and improved secondary outcomes, such as fasting blood sugar and BMI.

Telemedicine showed significant glycemic control improvement but minimal impact on BMI and quality of life.

Recommendations of the Researcher

Further research to explore unmeasured factors influencing telehealth effectiveness.

The researchers suggested further investigation into optimizing telehealth visit frequency and incorporating hybrid care models.

The researchers suggest integrating telehealth into routine diabetes management while conducting further research on its long-term impacts.

The study suggests integrating telemedicine into diabetes management but calls for further exploration of its effects on patient quality of life.

Explain how this article supports your proposed PICO(T) question and Capstone Change Project

The study aligns with the PICOT question by providing evidence of telehealth’s positive impact on compliance with diabetes management protocols, supporting its use as an effective alternative to in-person care.

This article answers the PICOT question and provides evidence that telehealth is a viable alternative to standard care for managing diabetes, as it specifically points toward compliance improvement. The findings underline telehealth's role in enhancing access and reducing barriers, which is important to go forward with the care of diabetes.

The article supports the PICOT question by demonstrating telehealth's potential to improve compliance and outcomes in diabetes management.

The study supports telehealth's effectiveness in improving compliance with diabetes management protocols, directly aligning with the proposed PICOT question. It highlights implications for enhancing nursing practices through innovative care delivery models.

Criteria

Article 5

Article 6

Article 7

Article 8

APA Reference

(include the GCU permalink or working link used to access the article)

Rodriguez, H. P., Ciemins, E., Rubio, K., Rattelman, C., Cuddeback, J. K., Mohl, J. T., Bibi, S., & Shortell, S. M. (2024). Telemedicine use and decrements to type 2 diabetes and hypertension care during the COVID-19 pandemic. BMC Digital Health, 2(1). https://doi.org/10.1186/s44247-023-00056-7

Sotomayor, F., Hernández, R. C., Malek, R., Parimi, N., & Spanakis, E. K. (2023). The Effect of Telemedicine in Glycemic Control in Adult Patients with Diabetes during the COVID-19 Era—A Systematic Review. Journal of Clinical Medicine, 12(17), 5673–5673. https://doi.org/10.3390/jcm12175673

Dhediya, R., Chadha, M., Bhattacharya, A. D., Godbole, S., & Godbole, S. (2022). Role of telemedicine in diabetes management. Journal of Diabetes Science and Technology, 17(3), 193229682210811. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10210114/

AlQassab, O., Kanthajan, T., Pandey, M., Francis, A. J., Sreenivasan, C., Parikh, A., & Nwosu, M. (2024). Evaluating the Impact of Telemedicine on Diabetes Management in Rural Communities: A Systematic Review. Cureus, 16(7). https://doi.org/10.7759/cureus.64928

Purpose/Aim of Study

To examine the effects of telemedicine use on the quality of diabetes and hypertension care during the COVID-19 pandemic.

The study evaluates telemedicine's effectiveness in managing diabetes during the COVID-19 pandemic, focusing on its impact on glycemic control measures like HbA1c and time-in-range (TIR).

The study aims to explore telemedicine’s role in diabetes management by evaluating its feasibility, effectiveness, and potential integration into routine care.

The study aims to evaluate the impact of telemedicine on glycemic control in diabetic patients in rural settings, identifying benefits, challenges, and potential improvements in diabetes management.

Research questions (Qualitative)/Hypothesis (Quantitative)

 Hypothesis : Telemedicine use was more strongly associated with blood pressure testing and control for adults with type II diabetes compared to those with hypertension-only

 Hypothesis : telemedicine improves glycemic control measures (e.g., HbA1c, TIR, GMI) compared to standard in-person care

Hypothesis: Telemedicine improves glycemic control and self-management compared to traditional in-person care.

Hypothesis: Telemedicine improves glycemic control (HbA1c) in rural diabetic patients compared to standard care.

Design

Type of quantitative or type of qualitative study design

A quantitative, retrospective cohort study using pre- and post-pandemic data

Quantitative, retrospective observational analysis with some prospective data components.

Quantitative meta-analysis and randomized controlled trials (RCTs).

Systematic review of recent studies on telemedicine in rural diabetes care.

Setting

Where did the study take place? What type of setting – inpatient, outpatient, etc.?

Outpatient settings across ten U.S. health systems.

Outpatient settings during the COVID-19 pandemic.

Outpatient care, including primary health care settings.

Studies were conducted in rural outpatient settings across various regions.

Sample

Number and characteristics of participants

1,963,563 adult patients diagnosed with type 2 diabetes and/or hypertension.

317 studies focused on non-pregnant adults with type 1 or type 2 diabetes.

Diverse studies covering over 20,000 participants, including adults with Type 1, Type 2, and gestational diabetes.

The review included 10 studies with participants aged 18+ from rural areas, totaling 20,000+ individuals.

Methods

Interventions/Instruments

Telemedicine encounters were analyzed for HbA1c and BP testing and control using electronic health records.

Use of telecommunication (e.g., video conferencing) with glucose monitoring tools (CGM, SMBG, FGM).

Telehealth interventions included telemonitoring, tele-education, and teleconsultation, evaluated for HbA1c levels and patient satisfaction.

The review assessed telemedicine interventions like remote monitoring and digital health tools.

Analysis

How were the data that were collected analyzed?

Generalized linear models and inverse propensity treatment weighting were applied to compare outcomes.

Data analyzed through glycemic measures (e.g., HbA1c, TIR), emphasizing statistical comparisons between telemedicine and in-person care.

Statistical analysis using meta-analyses, odds ratios, and cost-effectiveness evaluations.

Data were analyzed using PRISMA guidelines and quality appraisal tools, including meta-analysis and risk assessment frameworks.

Outcomes/key findings of the study and implications for nursing practice (Summary of study results)

Telemedicine reduced HbA1c and BP testing but did not significantly affect control rates. Implications highlight the need for hybrid care models.

Telemedicine showed improved glycemic control, highlighting its potential for diabetes care and implications for accessible management.

Telemedicine reduced HbA1c, improved diabetes self-management, and enhanced cost-effectiveness, though challenges remain for marginalized populations.

Telemedicine significantly improved HbA1c, medication adherence, and timely care while being cost-effective. It showed reduced effectiveness for patients with comorbidities.

Recommendations of the Researcher

Integrate remote monitoring tools and partnerships to complement telemedicine.

Further research is needed via randomized clinical trials to solidify telemedicine’s role post-pandemic.

The study recommends increase in telehealth accessibility and tailoring strategies for diverse populations.

Hybrid models combining telemedicine and in-person care, better infrastructure, and further randomized controlled trials were recommended.

Explain how this article supports your proposed PICO(T) question and Capstone Change Project

Supports the PICOT focus on telehealth by highlighting its limitations and potential in diabetes care, aligning with the capstone project’s aim to improve compliance.

The article supports the PICOT question by demonstrating telemedicine's effectiveness in improving diabetes compliance, aligning with the Capstone Change Project's goals.

The article validates telehealth as a viable method to enhance diabetes management compliance, directly addressing the PICOT question and advancing telehealth integration in nursing practice.

The article supports the PICOT question by demonstrating telemedicine’s efficacy in improving compliance with diabetes management protocols. Its findings align with the Capstone project, emphasizing innovative, accessible care approaches.