Date of Publication


Project Team

Erik Wilson RN; Carol Buck-Rolland EdD, APRN, PNP; Teresa Cahill-Griffin DNP, RN


  1. Background: In 2018, approximately one in seven Americans had been diagnosed with Type 2 Diabetes, a number that is projected to increase to one in three by 2050. Approximately 40% of individuals with Type 2 diabetes develop long-term complications, accounting for one-in-four healthcare dollars spent in the United States. Current initiatives supported through Accountable Care Organizations place an emphasis on improving the quality of care delivered in chronic medical problems such as diabetes to optimize patient outcomes, moving away from the traditional fee-for-service. One cornerstone of improving quality of care is care coordination and education.
  1. Methods: Utilizing the Plan-Do-Study-Act methodology of quality improvement, a care coordination and empowerment program was developed to determine gaps in patient knowledge, self-management, and redundancies in services. Patients meeting selection criteria were invited to participate in a diabetes care coordination and empowerment session directly following an upcoming appointment with their Primary Care Provider (PCP). Diabetes related empowerment was evaluated through the independently validated Diabetes Empowerment Scale-Short Form (DES-SF). DES-SF scores are considered as a way to measure higher-order self-efficacy correlated with successful clinical or education interventions.
  1. Results: Four participants met the selection criteria and were contacted for care coordination and empowerment session following a PCP visit. Three participants agreed to attend, one was unable to attend due to a schedule conflict with another provider. Of those that participated, empowerment scores increased by 4.27% overall following intervention, with subscale scores improving by 3.89%, 10.82% and 0% in psychosocial management, readiness for change and goal setting respectively.
  1. Conclusions: Participants realized an increase in diabetes related empowerment following care coordination sessions. Initial pilot program results indicate potential and a need for further investigation due to limited sample size

Keywords: diabetes, empowerment, care coordination, diabetes empowerment scale, clinical nurse leader, quality improvement, type 2 diabetes

Document Type


Available for download on Monday, May 13, 2024