Student Name
Capella University
NURS-FPX 6218 Leading the Future of Health Care
Prof. Name
Date
Change Proposal Summary Report
Effective management of diabetes requires consistent attention to foot health, as it directly influences patient outcomes and overall well-being. Preventive care for diabetic foot conditions—particularly complications such as Diabetic Peripheral Neuropathy (DPN) and foot ulcers—remains insufficiently prioritized across many healthcare systems in the United States. DPN is among the most common complications of diabetes and significantly increases the risk of ulceration and lower-limb amputation. Evidence suggests that nearly half of individuals with diabetes may develop neuropathy-related complications during their lifetime.
These complications not only deteriorate patient health but also place a substantial financial burden on healthcare systems due to prolonged treatment, hospital admissions, and rehabilitation needs (Galiero et al., 2023). This report outlines a proposed evidence-based improvement plan for the Southern West Virginia Health System (SWVHS), a rural healthcare provider. The goal is to strengthen preventive strategies, identify current care gaps, and align practices with international standards to reduce DPN and foot-related complications.
Executive Summary
What Change Is Being Proposed?
The proposed initiative focuses on improving diabetic foot care within SWVHS, where complications such as neuropathy, chronic pain, and ulceration are frequently observed. If left unmanaged, these conditions may progress to amputations. Rural populations served by SWVHS are particularly vulnerable due to limited access to preventive services.
West Virginia reports higher rates of diabetes-related amputations compared to other U.S. regions, largely due to disparities in healthcare access and preventive care delivery (Minc et al., 2020). Addressing this issue requires systematic improvements in screening, monitoring, and patient engagement.
The proposed interventions include:
- Increasing routine HbA1c testing and comprehensive foot examinations
- Expanding telehealth services for remote monitoring and consultation
- Implementing Electronic Health Record (EHR) alerts to standardize care delivery
According to the American Diabetes Association (ADA), approximately 15.7% of West Virginia’s population is living with diabetes, with over 10,000 new cases diagnosed annually (ADA, n.d.). These figures reinforce the urgency of strengthening preventive care strategies.
Research supports routine screening and glycemic monitoring as essential components of diabetes management. Telehealth has also proven effective in improving access to care, particularly for underserved populations, by enabling timely consultations and continuous monitoring (Hazenberg et al., 2020). Additionally, automated EHR reminders enhance adherence to screening protocols, making preventive care more consistent and cost-effective (Zhao et al., 2023).
Desired Outcomes
What Outcomes Are Expected From This Change?
The proposed interventions aim to improve both clinical outcomes and healthcare delivery efficiency. The primary objective is to reduce the incidence of diabetic foot complications, including infections, ulcers, delayed healing, and amputations. Early detection plays a critical role in preventing disease progression.
Key expected outcomes include:
- Reduction in complications: Early identification of risk factors enables timely intervention
- Improved access to care: Telehealth services allow patients in remote areas to receive consistent medical support
- Enhanced glycemic control: Regular HbA1c monitoring supports better diabetes management
- Increased patient engagement: Patients become more involved in self-care practices
NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
Telehealth solutions also contribute to fewer hospital visits, faster wound healing, and reduced ulcer formation (Hazenberg et al., 2020). Furthermore, EHR-based alerts ensure that both patients and providers adhere to recommended screening schedules, promoting proactive care.
However, implementation may face challenges such as:
- Financial costs associated with technology integration
- Resistance from healthcare staff due to increased workload
Successful adoption will depend on leadership support, adequate funding, and interdisciplinary collaboration.
Health Care System Comparative Analysis
How Do International Systems Manage Diabetic Foot Care?
A comparison with global healthcare systems highlights effective strategies that can inform improvements at SWVHS. The United Kingdom and Australia have implemented structured, evidence-based approaches that significantly reduce diabetic complications.
Comparative Table of Healthcare Systems
| Outcome Area | United Kingdom (NHS – NICE Guidelines) | Australia (NHMRC Guidelines) | United States (SWVHS) |
|---|---|---|---|
| Prevention of complications | Multidisciplinary teams and routine screenings reduce risks | Telehealth and guideline-based assessments minimize ulcers and DPN | Higher complication rates due to limited preventive care |
| Access to services | Coordinated care improves access in rural areas | Telehealth enhances accessibility in remote regions | Geographic and resource barriers limit access |
| Patient outcomes and safety | Strong patient education improves self-management | Regular assessments support early intervention | Delayed diagnosis leads to poorer outcomes |
Both systems emphasize structured guidelines, patient education, and multidisciplinary collaboration, which are critical for improving diabetic foot care outcomes.
Rationale for the Proposed Change
Why Is This Change Necessary?
The proposed improvements are grounded in established international best practices. Guidelines from the UK and Australia emphasize preventive care, early diagnosis, and patient education as essential components of diabetes management.
Telehealth is particularly relevant for rural healthcare systems like SWVHS, as it enables:
- Real-time communication between patients and providers
- Continuous monitoring without requiring travel
- Increased adherence to self-care routines
A multidisciplinary care model further enhances outcomes by integrating expertise from various healthcare professionals, ensuring coordinated and comprehensive treatment (Choi et al., 2023).
Since SWVHS already has some telehealth infrastructure, adopting these strategies is both practical and scalable. Aligning with global standards will improve patient safety and reduce disparities in care delivery.
Financial and Health Implications
What Are the Cost and Health Impacts?
Although initial implementation may require financial investment, the long-term benefits outweigh the costs. Preventive care strategies reduce the need for expensive treatments associated with advanced complications.
Short-term benefits include:
- Improved patient access to healthcare services
- Enhanced monitoring and early diagnosis
- Increased patient satisfaction
Long-term benefits include:
- Reduced hospitalization rates
- Lower healthcare costs
- Improved quality of life for patients
NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
Evidence shows that treating advanced diabetic foot complications is significantly more expensive than preventive care. Patients with foot ulcers incur costs up to five times higher than those without complications (Felix et al., 2023).
Failure to implement these changes could result in increased rates of neuropathy, amputations, and financial strain on both healthcare systems and patients.
Conclusion
Strengthening diabetic foot care practices within SWVHS is critical for improving patient outcomes and reducing complications. Integrating telehealth, routine screenings, and EHR-based monitoring systems will enhance preventive care and support early intervention.
Adopting evidence-based strategies from international healthcare systems will enable SWVHS to deliver more effective, equitable, and sustainable care. These improvements will not only reduce healthcare costs but also enhance the quality of life for individuals living with diabetes in rural communities.
References
American Diabetes Association (ADA). (n.d.). The burden of diabetes in West Virginia. https://diabetes.org
Casadei, G., Filippini, M., & Brognara, L. (2021). Glycated hemoglobin (HbA1c) as a biomarker for diabetic foot peripheral neuropathy. Diseases, 9(1), 16. https://doi.org/10.3390/diseases9010016
NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
Choi, T., Osuagwu, U. L., Tran, C., Bulsari, K., & Simmons, D. (2023). Impact of multidisciplinary care of diabetic foot infections. BMC Health Services Research, 23(1), 1126. https://doi.org/10.1186/s12913-023-10119-0
Felix, Uçkay, I., Boixader, S. L., Sydler, C., & Gariani, K. (2024). Costs related to diabetic foot disorders. Frontiers in Endocrinology, 14, 1323315. https://doi.org/10.3389/fendo.2023.1323315
NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
Galiero, R., et al. (2023). Peripheral neuropathy in diabetes mellitus. International Journal of Molecular Sciences, 24(4), 3554. https://doi.org/10.3390/ijms24043554
Hazenberg, C. E., et al. (2020). Telehealth applications for diabetic foot care. Diabetes/Metabolism Research and Reviews, 36(3), e3247. https://doi.org/10.1002/dmrr.3247
Kaminski, M. R., et al. (2022). Australian guidelines for diabetic foot prevention. Journal of Foot and Ankle Research, 15(1). https://doi.org/10.1186/s13047-022-00534-7
Minc, S. D., et al. (2020). Amputation rates in West Virginia. Journal of Vascular Surgery, 71(5), 1708–1717. https://doi.org/10.1016/j.jvs.2019.06.215
NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
National Health Service (NHS). (n.d.). Diabetes footcare pathway blueprint.
Zhao, N., et al. (2023). Screening behaviors for diabetic foot risk. BMC Primary Care, 24(1). https://doi.org/10.1186/s12875-023-02027-3