Quality Improvement: Proposal for Telephonic Health Promotion By an MS Nurse
People with multiple sclerosis (MS) have physical and mental health needs both within and beyond their MS. Health promotion reduces MS disease progression and also ameliorates other health problems. Barriers to care include lack of transportation, impaired mobility, limited finances, and lack of resource availability. The Kootenai Neurology Clinic (KNC) has the only MS fellowship trained physician in Northern Idaho. There are no multidisciplinary resources within the clinic to support the patients’ health promotion.
A telephonic health promotion intervention using motivational interviewing was shown to eliminate many barriers and led to improvements in physical and mental health for people with MS (Bombardier et al., 2008). This DNP quality improvement project aims to use an MS certified nurse (MSCN) clinical navigator within KNC to implement a pilot trial with 10 patients, using Bombardier’s intervention model as a framework. Primary objective is improvement in health promotion goals related to fatigue management and stress reduction, which has been shown to lead to improvement in the patient’s physical and mental health. There are also process outcomes to monitor barriers. If the pilot is successful, it will be the basis for a full-scale implementation of this intervention within the clinic.
Preparations. The DNP student, who is also the MSCN clinical navigator, will create the data tracking tool and the post-survey. The MSCN will attend a 2 day training on Motivational Interviewing (MI), as this is the interview technique used previously. The MSCN will educate the MS physician on the scope of the project and scripting as needed. Patients will be identified by referral from the MS provider, who will fill out the referral sheet to highlight reasons the patient is being referred.
Program. The program is comprised by an initial meeting with the MSCN, then scheduled telephone calls at weeks 1, 2, 4, 8, and 12. Initial health promotion goals are set during the first meeting, with the MSCN using MI techniques to guide the patients in identifying priorities. During each follow up call progress to the goals is discussed and charted using the Goal Attainment Scale (GAS). The patient’s progress is used a starting point for further MI-based discussions to modify or expand the existing goals.
Follow up. Following the completion of the fifth scheduled phone call, the patients will be asked to complete the post-survey. This data will be the basis for evaluating and planning further implementation of the program. Data from during the intervention period will also be compiled, such as number of calls, length of calls, and scores on GAS. When all 10 patients have completed the 12 week program, the pilot will conclude. The MSCN will meet with stakeholders within KNC, discuss successes and weakness of the pilot program, and create a guideline for ongoing implementation of the program.