Publication Date



Background and Purpose: This evidence-based project conducted a practice change in a primary care setting to improve provider adherence in monitoring, treating and documenting LDL-C management for adults with type 2 diabetes.

Methods: The project was conducted over 8 weeks. A clinical support tool, the Diabetic LDL Protocol, was developed for the clinic to implement into practice. The providers were instructed to use the tool during each encounter with an adult diabetic patient. Pre- and post-implementation data were abstracted from the electronic health records of 41 patients with type 2 diabetes during the implementation period.

Conclusions: The providers’ adherence rate for use of the Diabetic LDL Protocol peaked at 6 weeks post-implementation and declined steadily by 8 weeks. The tool was only used during 29% of the applicable patient visits. Communication issues during implementation of the protocol and electronic health record system restrictions were contributing factors to poor adherence.

Implications for Practice: The use of a clinical support tool may promote adherence to guidelines for diabetic patients in primary care. Integrating the tool into the workflow of a primary care practice and encouraging use of the tool are the major challenges of successful implementation. Further research is necessary to investigate strategies that can overcome clinical inertia and increase provider willingness to comply with new electronic protocols.

Author Supplied Keywords

Type 2 diabetes, Diabetes, LDL-C, Quality improvement, Primary care, Praictice change, Clinical support tool, Clinical inertia


Electronic health records; Diabetes; Diabetes mellitus

Publication Information

NRS 597: Practice Improvement Project.

Copyright for this work is retained by the authors.



Document Type

Doctoral Project

Included in

Nursing Commons