Telehealth DNP Dissertation Projects
Detailed Project Examples with Implementation Frameworks
1. Chronic Disease Management via Telehealth
Project Title: “Implementation of Remote Patient Monitoring for Heart Failure Management in Rural Primary Care Settings”
Background & Significance:
- Heart failure affects 6.2 million Americans with 30-day readmission rates of 20-25%
- Rural populations face 40% higher cardiovascular mortality rates
- Remote monitoring can reduce hospitalizations by 15-20%
PICOT Question: In adult patients with heart failure in rural primary care settings (P), how does implementation of telehealth remote monitoring with structured nurse practitioner follow-up (I) compared to standard care (C) affect 30-day readmission rates, medication adherence, and quality of life scores (O) over 6 months (T)?
Theoretical Framework:
- Chronic Care Model (Wagner et al.)
- Technology Acceptance Model for healthcare adoption
- Social Cognitive Theory for behavior change
Methodology:
- Design: Quasi-experimental with historical controls or randomized controlled trial
- Sample: 60-100 patients with NYHA Class II-III heart failure
- Setting: 2-3 rural primary care clinics
- Intervention: Daily weight monitoring, symptom tracking app, weekly NP telehealth visits
- Outcomes: Primary – 30-day readmissions; Secondary – medication adherence (Morisky scale), quality of life (Kansas City Cardiomyopathy Questionnaire)
Implementation Timeline:
- Months 1-3: IRB approval, staff training, technology setup
- Months 4-6: Patient recruitment and baseline data collection
- Months 7-12: Intervention implementation
- Months 13-15: Data analysis and dissemination
2. Mental Health Integration Project
Project Title: “Telehealth-Delivered Collaborative Care Model for Depression Screening and Management in Primary Care”
Background & Significance:
- 40% of primary care patients with depression receive inadequate treatment
- Collaborative care models improve outcomes by 20-30%
- Telehealth can address psychiatric provider shortages
PICOT Question: In primary care patients with newly diagnosed depression (P), how does a telehealth collaborative care model with psychiatric consultation and care coordination (I) compared to usual primary care management (C) affect depression severity scores, treatment adherence, and patient satisfaction (O) over 3 months (T)?
Theoretical Framework:
- Collaborative Care Model (IMPACT study framework)
- Behavioral Activation Theory
- Self-Determination Theory for motivation
Methodology:
- Design: Pragmatic randomized controlled trial
- Sample: 80-120 patients with PHQ-9 scores ≥10
- Intervention: Weekly telehealth sessions with psychiatric NP, care coordination, medication management
- Outcomes: PHQ-9 scores, medication adherence, Patient Satisfaction Questionnaire
Key Implementation Elements:
- EMR integration for care coordination
- Standardized protocols for psychiatric consultation
- Training modules for primary care staff
- Patient education materials
3. Health Equity and Access Project
Project Title: “Culturally Adapted Telehealth Diabetes Self-Management Program for Hispanic/Latino Adults”
Background & Significance:
- Hispanic adults have 70% higher diabetes prevalence
- Cultural barriers affect diabetes management
- Limited Spanish-language telehealth resources
Theoretical Framework:
- Cultural Competence Framework (Campinha-Bacote)
- Social Ecological Model
- Diabetes Self-Management Theory
Methodology:
- Design: Community-based participatory research approach
- Sample: 50-75 Hispanic adults with Type 2 diabetes
- Intervention: 12-week culturally adapted telehealth program with bilingual diabetes educator
- Outcomes: HbA1c levels, diabetes self-efficacy, cultural competency satisfaction
Cultural Adaptations:
- Family involvement in sessions
- Spanish-language materials
- Integration of traditional foods and remedies
- Community health worker support
4. Quality Improvement Project
Project Title: “Reducing Diagnostic Delays through AI-Enhanced Telehealth Dermatology Consultations”
Background & Significance:
- Average wait time for dermatology appointments: 35 days
- 30% of skin cancers could be diagnosed earlier with telehealth
- AI diagnostic tools show 90%+ accuracy for common conditions
QI Framework: Plan-Do-Study-Act (PDSA) cycles with Lean methodology
Methodology:
- Design: Quality improvement with pre-post comparison
- Sample: 200 patients requiring dermatology consultation
- Intervention: Standardized photography protocol, AI pre-screening, telehealth consultation
- Outcomes: Time to diagnosis, diagnostic accuracy, patient satisfaction, cost analysis
Implementation Strategy:
- PDSA Cycle 1: Photography standardization training
- PDSA Cycle 2: AI tool integration
- PDSA Cycle 3: Provider workflow optimization
Research Design Considerations
Sample Size Calculations
- Use power analysis (G*Power software)
- Consider 20% attrition rate for longitudinal studies
- Account for cluster effects in multi-site studies
Data Collection Strategies
Quantitative Measures:
- Validated instruments (PHQ-9, GAD-7, SF-36)
- Clinical outcomes from EMR
- Cost-effectiveness data
- Technology usability scores
Qualitative Components:
- Semi-structured interviews with patients and providers
- Focus groups for implementation feedback
- Observational data on workflow changes
Technology Considerations
Platform Selection Criteria:
- HIPAA compliance and security features
- Integration capabilities with existing EMR
- User interface accessibility
- Multi-language support
- Cost and scalability
Common Platforms:
- Epic MyChart telehealth
- Doxy.me
- Zoom for Healthcare
- Microsoft Teams for Healthcare
Implementation Science Frameworks
RE-AIM Framework
- Reach: Who participates and why?
- Effectiveness: What are the outcomes?
- Adoption: Which settings implement?
- Implementation: How consistently delivered?
- Maintenance: Is it sustained long-term?
Consolidated Framework for Implementation Research (CFIR)
- Intervention characteristics
- Outer setting factors
- Inner setting factors
- Individual characteristics
- Implementation process
Budget Considerations
Typical DNP Project Costs
- Technology platform fees: $5,000-15,000
- Research materials and surveys: $1,000-3,000
- Data analysis software: $500-2,000
- Staff time and training: $10,000-25,000
- Equipment (tablets, cameras): $2,000-5,000
Funding Sources
- Health system quality improvement funds
- Professional organization grants (AANP, NONPF)
- Technology company partnerships
- Federal grants (HRSA, AHRQ small grants)
Regulatory and Ethical Considerations
IRB Requirements
- Multi-site agreements if applicable
- HIPAA compliance documentation
- Informed consent for telehealth participation
- Data security and storage protocols
State Licensing Issues
- Interstate practice regulations
- Scope of practice considerations
- Prescribing across state lines
- Emergency protocols for remote care
Dissemination Strategies
Academic Publications
- Tier 1 Journals: Journal of Medical Internet Research, Telemedicine and e-Health
- Nursing Journals: Journal of the American Association of Nurse Practitioners, Applied Nursing Research
- Specialty Journals: Based on clinical focus area
Professional Presentations
- American Association of Nurse Practitioners Annual Conference
- American Telemedicine Association meetings
- Regional nursing research conferences
- Health system quality improvement showcases
Policy Impact
- State nursing organization position statements
- Healthcare system policy recommendations
- Regulatory feedback to CMS or state boards
Timeline and Milestone Planning
24-Month DNP Project Timeline
Months 1-6: Planning Phase
- Literature review completion
- Theoretical framework selection
- Methodology finalization
- IRB submission
- Site agreements and partnerships
Months 7-12: Implementation Phase
- Staff training and orientation
- Technology deployment
- Patient recruitment
- Baseline data collection
- Intervention launch
Months 13-18: Data Collection Phase
- Ongoing intervention delivery
- Regular data collection
- Mid-point analysis and adjustments
- Stakeholder feedback sessions
Months 19-24: Analysis and Dissemination
- Final data collection
- Statistical analysis
- Manuscript preparation
- Presentation development
- Final project defense
Success Metrics and Benchmarks
Clinical Outcomes
- 15-20% improvement in primary outcome measures
- Statistical significance (p<0.05) for key variables
- Clinically meaningful effect sizes (Cohen’s d >0.5)
Implementation Outcomes
- 80% participant retention rates
- 70% provider satisfaction scores
- <5% technical failure rate
- Cost-neutral or cost-savings demonstrated
Dissemination Success
- 1-2 peer-reviewed publications
- 2-3 professional presentations
- Policy or practice change adoption
- Media coverage or professional recognition
