Date of Conferral

6-5-2024

Date of Award

June 2024

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Deborah Lewis

Abstract

Diabetes is the seventh leading cause of death for adults in the United States. Evidence suggests that not all patients receive the same level of care and discrepancies may be based on the type of health care coverage they have. Providers use Hemoglobin A1C (A1C) as the primary test to indicate treatment success for persons with diabetes. Providers may be ordering this critical lab value differently based on the patient’s insurance plan. In this project, A1C levels in diabetic patients receiving managed care versus traditional Medicare were evaluated. It is important to understand if potential disparities in care exist. The chronic care model was used to guide this project. A retrospective chart audit and statistical analysis was used to investigate A1C differences among 40 individuals aged 65 and above with diabetes. Deidentified A1C lab data spanning 4 months in 2023 were collected, with 20 data points for each group, comparing traditional Medicare and managed care patients. There were similarities in mean and median but differences in mode and variance. The traditional Medicare group had a mean of 6.01 and the managed care group had a mean of 6.35. The traditional Medicare group exhibited a wider A1C value spread, with the mode in the managed care group of 5.8 nearly aligned with standard therapeutic levels 5.7 or below. The t test resulted in a non-significant p value of 0.119, attributed to higher variance and a small sample size. The project suggests the need for emphasizing protocol compliance for diabetes management in each setting, but especially in the traditional Medicare group. Social change would be impacted if all providers consistently followed evidence-based guidelines for timely A1C assessments resulting in improved health outcomes for all adult patients with diabetes.

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