Rebecca Mickel

Publication Date



The financial cost of managing diabetes in Oregon is unsustainable. Furthermore, the physical consequences for patients can be devastating (American Diabetes Association [ADA], 2019). One solution to improve the management of diabetes is shared provider-patient decision making (Larme, A., & Pugh, J., 2001). The Goal Attainment Scale (GAS) method, was initially used and successful in mental health for improving self-care activities (Newton, 2013) and it appears to be a viable solution for improving collaborative goal setting to enhance self-care for patients with diabetes.

This practice improvement project focuses on the use of the GAS method to facilitate collaborative goals setting between a group of providers and patients with diabetes at one family practice clinic. For eight weeks, there were forty-eight qualifying encounters for forty patients with diabetes at the clinic and thirteen patients developed goals (32%) using the GAS method. The remaining twenty-seven patients (68%) refused to participate, or they were not ready to make a change in self-care of diabetes. Five of the thirteen patients with GAS goals returned for additional visits and of this group either maintained or improved on the scale during the eight weeks. The level of provider engagement and motivation in goal setting varied; however, the patients who developed GAS goals demonstrated a commitment to caring for their diabetes. The primary benefit of the GAS tool was patient involvement.


Diabetes; Diabetics--Care; Disease management--Oregon; Self-care, Health

Publication Information

Copyright for this work is retained by the author.

NRS 662 - DNP Scholarly Project III

Document Type

Doctoral Project