The evidenced based evaluation tool

The evidenced based evaluation tool that will be used in this quality improvement project is a validated food frequency questionnaire from the DASH Eating Plan manual from the National Institute of Health (NIH, 2006). The pre-intervention questionnaires are to assess their knowledge and belief of the DASH diet pre-intervention. The post-intervention questionnaires are to evaluate the effectiveness of education by re-evaluating knowledge and belief after DASH education. The post-intervention questionnaires are to be administered at the end of the 4-week session. The post-intervention evaluates the effectiveness of the DASH diet session. Blood pressure measurement is taken pre-and post-educational intervention. Blood pressure will be measured pre-intervention and post-intervention to allow adequate time for adjustment. The blood pressure is taken using a mercury manual sphygmomanometer. A blood pressure reading by auscultation is considered the gold standard according to (NHLBI, 2017). Blood pressure will be measured in the left and right arms in the sitting position. Medical contraindications for blood pressure measurements in either arm (i.e., double mastectomy, poor circulation, arteriovenous shunt) will be excluded from the DPI. Blood pressures will be taking in the morning on arrival. The patient’s blood pressure will be documented in the electronic health record in the vital signs section. The blood pressure will be measured to evaluate if the significant reduction in blood pressure is obtained in the patients that followed the DASH. Blood pressure will be recorded on paper, then entered on an Excel flow sheet in the computer system.  Comment by Sharina Sigur: In general, APA style recommends using words to express numbers below 10 and using numerals when expressing numbers 10 and above.

The plan for evaluation of this practice change project is to administer a five question pre-and post-test measuring the effectiveness of the lesson, educating patients on the use of the DASH diet for HTN management and measuring patients’ blood pressures before and after the intervention. The validated DASH pre-post-test tool is free to use and does not require the author’s permission to use it. The DASH questionnaire, created by the DASH for Health team, was initially used in an online format and validated against the well-known Block Food FFQ by Apovian et al. (2010). The Block FFQ and the DASH online questionnaire (OLQ) were found to have significant positive correlations among all eleven DASH food groups (Apovian et al., 2010). Weighted kappa statistics found the level of alignment between the DASH OLQ and the Block FFQ by energy level to have a value of 0.48 (95% CI 0.38, 0.57; P < 0.0001) meaning moderate agreement was observed (Apovian et al., 2010). The DASH questionnaire is based on a diet recall from the previous 24 hours only and encompasses 11 dietary categories with additional questions to determine sodium and fat intake (Apovian et al., 2010). The estimated time for the questionnaires would take participants approximately 20 minutes to complete and would not feel burdensome and could be given on paper. The DASH questionnaire tools, are free for public use (NHLII, 2006).

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Data Collection Procedures Comment by Sharina Sigur: Underdeveloped.

             The DPI student will oversee storing and securing the intake data for all participants. The demographic data collected for this project willinclude the following: 1) age, 2)ethnicity, and 3) gender. Other demographics that will be collected for the electronic health record is the participants systolic and diastolic numbers of patients that are diagnosed with hypertension and will participate in the DPI. Onsite de-identified data will be collected by the clinical staff. The clinical staff will provide the education intervention and give the pre-posttest to patients before and after the education intervention. The clinical staff will also obtain de-identified blood pressures from patients at the beginning and end of quality improvement project. Data collection will also include the number of hypertension patients that received the counseling for the DASH diet during their visit to the clinic. Clinical staff will include Registered Nurses and Medical Assistants.

The questionnaires will be placed in a labeled folder and placed, secured, and locked in a file cabinet. The intake surveys and questionnaires will be coded with number and each participant will be given a separate number that will not contain any identifying patient’s information. All data collected will remain secured until the data can be entered into the Excel spreadsheet and the SPSs program. Once the DPI project has completed, the pre-post questionnaires will be shredded in the office locked shred box 6 months after intervention and sent out for bulk disposal. The SPSS Excel information will be stored on the designated office computer that requires username and password for access. The Excel spreadsheet will also be password protected.

Data Analysis Procedures Comment by Sharina Sigur: This section is underdeveloped.

To answer the clinical question, “Does the implementation of a Dietary Approach to Stop Hypertension education intervention impact African American patients diagnosed with hypertension at a primary health clinic in Washington, D.C. over a four-week period?”, SPSS statistical software will be used examine the correlation between the independent and dependent variables. Comment by Sharina Sigur: Indent the first line of each paragraph of text 0.5 in. from the left margin.

The independent variable will be defined as the implementation of a Dietary Approach to Stop Hypertension education session for patients that are diagnosed with HTN. The dependent variable will be the blood pressures measurements of patients identified in the QI project at a primary health clinic in Washington, D.C. over a four-week period. 

The patient’s blood pressures before and after the intervention will be entered into an Excel spreadsheet. Data analysis will be performed using SPSS statistical software. The research department of clinical investigation at the clinical site will provide statistician assistance. At the end of the four-week evaluation, the posttest scores will be compared to prior posttest scores using descriptive statistics and T-test to compare retained knowledge and rate of DASH counseling with a percentage value of .05 as the benchmark. This project may not reach statistical significance therefore a percentage change will be collected from the pre-and post-test to determine the amount of knowledge gained and the number of patients’ blood pressures that will be measured.  This data will provide the information to ascertain if the intervention of the DASH from patients had a positive patient outcome for those patients diagnosed with HTN over the four-week period. 

Collected data will be presented in tables and pie and chart graphs and analyzed by the computer software statistical package (SPSS version 27) using appropriate statistical methods. Frequency means and standard deviation will be used to summarize the data. Categorical data will be analyzed by using chi-square test. Descriptive frequency and statistics will be used to compute Demographics.

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