Jamie Mathis, MSN, RN, NE-BC, associate administrator, Population Health and Disease Management, Ambulatory Care Services, Harris Health System in Houston, was charged with opening and operating six same-day clinics within the healthcare system and successfully met the goal of expanding access in primary care and relieving congestion to emergency care centers.
Q: Part of evidence-based practice is getting input from patients on what works for them. Can you give an example of when EBP is not used?
Q: Why is it important that nurses use EBP in the ambulatory care setting?
Q: How do you help nurses implement EBP in the ambulatory care setting?
Q: How do you help patients and their families learn about EBP care so they can implement those practices at home?
Q: What obstacles are you overcoming when working with staff on instituting EBP in their practices and in educating patients and families?
Mathis recently answered some questions from Nurse.com about using evidence-based practice in the ambulatory care setting.
A: For me it’s more about knowing what you’re doing and why you’re doing it versus somebody telling you, “This is what you need to be doing,” because we need to really focus on patient safety and the quality of care the patients are receiving. The ultimate goal is to improve patient outcomes.
A: When I was an administrator for the six same-day clinics, I had six charge nurses, and every month a charge nurse had to pick an evidence-based practice topic, such as pneumonia or asthma, that was relevant to our patient population. The nurses did the research and tied everything together.

They create a five-page PowerPoint presentation, and I would review it and send it to the entire team. It’s called an “evidence-based practice blast.” It was an educational tool for everybody.
A: I oversee the patient education department, which consists of diabetes-certified educators. They use the findings of the Diabetes Prevention Program in their work. DPP was a major multicenter clinical research study aimed at discovering whether modest weight loss through dietary changes and increased physical activity or treatment with the oral diabetes drug metformin (Glucophage) could prevent or delay the onset of type 2 diabetes in study participants.

Through this research it was determined that millions of people can delay or avoid developing type 2 diabetes by losing weight through regular physical activity and a diet low in fat and calories. DPP also showed evidence that using metformin can help delay the onset of diabetes, as well. When a referral is made for the patient educators to teach the patient our basic pitch is, “You're being referred because we actually want to avoid diabetes complications. You’re in a high-risk group, and we want to prevent you from getting diabetes. There are millions of people in your category, but if you do these things, it will delay or avoid type 2 diabetes.”
A: We’ve got to get the patient in to have the conversation. A lot of patients, once they see the physician, don’t really see the value of actually having a patient educator, a nutritionist, a case manager [follow them], who all report to me. When those patients actually do meet with my staff, we see a lot of improvement. For example, in one of our health centers there was a definite buy-in by staff with introducing themselves, their roles in the patient's healthcare and explaining the roles of others who would be assisting in supporting them with their healthcare — in particular their diabetes care.

Their HgA1c decreased at a much faster rate in 3 months versus some of the other health centers whose staff members did not explain their role with the patient's healthcare.
For me it’s more about knowing what you’re doing and why you’re doing it versus somebody telling you, ‘This is what you need to be doing.’”
— Jamie Mathis, RN
A: Physicians run a tight schedule, and they want to answer as many questions as they can when the patient is right in front of them. But sometimes the patients feel like the physicians are rushed, or they may forget to ask the physician something about their diet.

What my team tries to do is individualized, planned care. We ask questions like, “Tell us about what you’re eating. When do you eat it? How much do you eat? OK, you eat flour tortillas. Have you tried corn tortillas? We’re not telling you not to eat tortillas, but do modifications.”
EDITOR'S NOTE: Tom Clegg is a freelance writer.
Impressive results
One of the tenets of evidence-based practice regarding population health is the importance of getting people vaccinated for the flu and pneumonia. Through continuing education and coaching of staff, including monthly evidence-based practice blasts, at the same-day clinics that Jamie Mathis, RN, established in the Harris Health System in Houston, the rate of patients who received pneumonia vaccines improved by 44% from mid-2015 to mid-2016.

Also, the rate of those who received flu vaccines improved by 33% over the same time period. Because of continuing interprofessional patient education and coaching of staff, including monthly evidence-based practice blasts, at the same-day clinics in the Harris Health System in Houston by Jamie Mathis, RN, the rate of patients who received pneumonia vaccines improved by 44% from mid-2015 to mid-2016, and the rate of those who received flu vaccines improved by 33% over the same time period.
It’s hard enough for people to go to their physician. Now you’re asking them to come to another patient education visit. We try to get them in the same day, but sometimes asking a patient to leave their job, try to get child care to go to another appointment and have an in-depth conversation about their chronic condition or possible chronic condition can be a little challenging for us. My role is population health and disease management, and I oversee the community outreach department, as well. It’s hard to figure out if you’re actually making a difference in the community and at health fairs and health promotions. If you have 200 people that come to a health fair about diabetes, how do you know what you did made a difference in that community?
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