| Course | IHP 604 Healthcare Quality and Improvement |
|---|---|
| Module | Module 3 |
| Paper type | graduate milestone framing a quality improvement problem |
| Length | About 1,020 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MS Healthcare Administration |
| Updated | September 2026 |
Free sample paper for IHP 604 Module 3
Milestone One: Poor Diabetes Control at Crestline Medical Group
[Student Name]
Southern New Hampshire University
IHP 604: Healthcare Quality and Improvement
Module Three Milestone One
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Milestone One: Poor Diabetes Control at Crestline Medical Group
The final project for this course is a quality improvement report on a problem in a real or realistic organization. This milestone chooses that problem, poor diabetes control at Crestline Medical Group, and frames it with baseline data, evidence of why it matters, a look at variation and inequity and an aim statement that will anchor the work to come.
The Organization
Crestline is a physician-owned primary care group with 18 clinics across a metropolitan area and two surrounding rural counties. It employs 96 physicians and advanced practice clinicians and serves about 118,000 patients, of whom about 14,200 are adults with diabetes. About a third of its revenue now comes from contracts that pay bonuses or impose penalties based on quality measures, including diabetes control.
The Quality Gap
Using the measure defined in Module Two, 31% of Crestline's adults with diabetes show a latest A1c higher than 9% or lack any result for the past twelve months. That is about 4,400 people. Of these, roughly 1,100 have no recent test at all, and the remaining 3,300 have a result above 9%. The share has hovered between 29% and 33% for three years, so the problem is stable rather than a recent blip.
Table 1. Baseline Diabetes Control, Most Recent Twelve Months
| Group | Adults with diabetes | A1c above 9% or missing | Rate |
|---|---|---|---|
| All clinics | 14,200 | 4,400 | 31% |
| Best-performing clinic | 640 | 122 | 19% |
| Worst-performing clinic | 910 | 400 | 44% |
| Preferred language English | 11,300 | 3,280 | 29% |
| Preferred language Spanish | 2,400 | 940 | 39% |
Note. Composite registry data; about 500 patients with other preferred languages are not shown.
How Crestline Compares
Ali et al. (2013) examined national survey data from 1999 to 2010 and found that the share of U.S. adults with diabetes meeting recommended A1c targets improved over the period, yet about half still did not reach them, and only a small minority met combined targets for A1c, blood pressure, cholesterol and nonsmoking. Younger adults and some racial and ethnic groups were less likely to meet goals. Crestline is not an outlier, but that is little comfort; national performance shows how much room remains.
Why Control Matters Early
Laiteerapong et al. (2019) followed more than 34,000 patients with newly diagnosed type 2 diabetes in a large integrated health system and found that those whose A1c remained elevated during the first year after diagnosis had higher risks of microvascular and macrovascular complications and of death over the following years than those who reached good control early. That legacy effect means delays in getting newly diagnosed patients under control may cause harm that later improvement cannot fully undo. About 900 of Crestline's patients were diagnosed within the past year, and 27% of them already sit in the above-9% group.
Variation Between Clinics
Clinic rates range from 19% to 44%. Some of that spread reflects differences in patients, such as income and insurance, but the two clinics with the lowest rates serve populations similar to several of the highest. The best performers share two features: a care manager who calls patients after a high result and a monthly team review of a registry list. Variation of this kind suggests that practices, not just patients, drive results.
An Equity Gap
Spanish-speaking patients have a rate of 39%, compared with 29% for English speakers. Peek et al. (2007) reviewed interventions aimed at diabetes disparities and noted that racial and ethnic minority patients in the United States experience worse control and more complications. Interventions that were culturally tailored, used community health workers or provided one-on-one contact with feedback showed the most promise. Crestline has only four bilingual care staff for 2,400 Spanish-speaking patients with diabetes, and its education classes are offered only in English.
Costs and Contract Exposure
Two health plan contracts pay Crestline a bonus of about $1.1 million a year if poor control falls below 25%, which it has never reached. Beyond contracts, patients with uncontrolled diabetes use more emergency and hospital care, and complications such as dialysis carry very high costs to patients and payers even when they fall outside Crestline's own budget.
What Has Been Tried
Crestline has made two earlier attempts. Three years ago, it sent quarterly letters to patients above 9% urging them to schedule a visit; response was under 10%, and the rate did not move. Last year, it began sharing clinic rankings at the monthly physician meeting. Several clinicians described the rankings as unfair because they did not account for patient income, and the lowest-ranked clinics saw no improvement. Both efforts relied on exhortation rather than changes to how care is organized, and neither was tested on a small scale before being applied to every clinic. The lesson is that a stronger approach will need to change processes and build in learning from the start.
Problem Statement
Across Crestline's 18 clinics, 31% of adults with diabetes, about 4,400 people, have an A1c above 9% or no recent test, a rate unchanged for three years, with wide variation between clinics and a 10-point gap for Spanish-speaking patients. This exposes patients to preventable complications and costs the group quality bonuses.
Aim Statement
By the end of eighteen months, Crestline will reduce the share of adults with diabetes whose A1c is above 9% or missing from 31% to 24%, while narrowing the gap between Spanish- and English-speaking patients to no more than 4 percentage points and without an increase in hypoglycemia visits.
Boundaries
The project covers adults 18 to 75 with diabetes in all 18 clinics. It will not address pediatric diabetes, pregnancy-related diabetes or specialty endocrinology practices outside the group. Blood pressure and cholesterol control matter but will be addressed in a later project to keep this one focused.
Questions for the Next Milestones
Milestone Two will ask why so many patients remain above 9% and which evidence-based interventions best match those causes. Milestone Three will report the results of small tests of change and plan how successful changes can spread across all clinics.
Conclusion
Poor diabetes control at Crestline is large, persistent, uneven across clinics and worse for Spanish-speaking patients. It carries clinical and financial consequences and appears to be driven in part by practices the group can change. That makes it a strong candidate for a structured improvement effort.
References
Ali, M. K., Bullard, K. M., Saaddine, J. B., Cowie, C. C., Imperatore, G., & Gregg, E. W. (2013). Achievement of goals in U.S. diabetes care, 1999-2010. New England Journal of Medicine, 368(17), 1613-1624. https://doi.org/10.1056/NEJMsa1213829
Laiteerapong, N., Ham, S. A., Gao, Y., Moffet, H. H., Liu, J. Y., Huang, E. S., & Karter, A. J. (2019). The legacy effect in type 2 diabetes: Impact of early glycemic control on future complications (the Diabetes & Aging Study). Diabetes Care, 42(3), 416-426. https://doi.org/10.2337/dc17-1144
Peek, M. E., Cargill, A., & Huang, E. S. (2007). Diabetes health disparities: A systematic review of health care interventions. Medical Care Research and Review, 64(5 Suppl.), 101S-156S. https://doi.org/10.1177/1077558707305409
What the IHP 604 Module 3 instructions ask for
Milestone One in IHP 604 typically asks you to pick one measurable gap in care and set it up for an improvement project: organizational context, baseline data, evidence of why the problem matters, variation and an aim statement. Allow three to five APA 7 pages. Use a clearly defined measure, present baseline figures in a table, show whether the problem is stable over time and look for differences between sites or patient groups. Write the aim so it states how much improvement, by when and for whom, and include any conditions such as avoiding harm. IHP 604 graders notice clean headings in IHP 604 papers. IHP 604 names and dates need checking before IHP 604 submission. IHP 604 prompts vary by term, so recheck IHP 604 directions.
How this IHP 604 Module 3 milestone one example is built
This milestone frames poor diabetes control at a composite 18-clinic group: 31% of about 14,200 adults have an A1c above 9% or no recent test. A table shows clinic rates from 19% to 44% and a 10-point gap for Spanish-speaking patients. Ali and colleagues give national context, Laiteerapong and colleagues' legacy effect study shows why early control matters and Peek, Cargill and Huang's review frames the equity gap. The aim is to reach 24% in eighteen months while narrowing the language gap without raising hypoglycemia visits. IHP 604 students can reuse this structure for IHP 604 work. IHP 604 claims here trace to cited IHP 604 sources. IHP 604 readers can adapt each section to IHP 604 data.
Where the IHP 604 Module 3 rubric puts the points
Instructors grading this milestone look for a clearly identified quality problem, a defined measure with baseline data, evidence of the problem's importance, attention to variation and equity, a specific and time-bound aim, appropriate boundaries, scholarly support and APA 7. The strongest submissions show that the problem is persistent rather than a one-time dip and use variation to hint at causes. Marks are lost when the aim states a direction but no target or deadline, when baseline data are missing or when the problem is too broad for one project. IHP 604 marks favor careful formatting across IHP 604 sections. IHP 604 citations keep every IHP 604 argument credible. IHP 604 instructors weigh evidence heavily in IHP 604 grading.
IHP 604 Module 3 help: the mistakes that cost points
Quality problem milestones in IHP 604 often fall short because the aim reads as a wish, such as improve diabetes care, rather than a measurable target, or because baseline data cover a single month. Another frequent gap is ignoring differences between patient groups. Define the measure, show at least a year of baseline, break results down by site and population and write an aim with how much, by when and for whom. Share your organization's data and the IHP 604 prompt so the framing fits your project. IHP 604 drafts start well from a IHP 604 outline. IHP 604 feedback already received guides IHP 604 revisions. IHP 604 rubrics posted in Brightspace clarify IHP 604 expectations.
Get IHP 604 Module 3 written to your instructions
Send the IHP 604 Milestone One prompt and the quality problem you have chosen. The milestone will present baseline data, show variation and equity gaps, explain why the problem matters and write a measurable aim, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
More IHP 604 papers and related MS Healthcare Administration samples
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IHP 604 Module 3 questions, answered
Where can I find a free IHP 604 Module 3 Milestone One sample?
IHP 604 Module 3 appears in full as a framing of poor diabetes control with baseline data, clinic variation, an equity gap and an aim.
What is an aim statement?
A specific statement of how much improvement will be achieved, by when and for which patients, sometimes with conditions such as avoiding harm.
Why show variation between clinics?
Wide differences among similar sites suggest that practices, not only patients, drive results, which points toward changes worth testing.
Should equity be part of a quality problem?
Yes; breaking results down by language, race or insurance shows whether some groups are left behind.
How much baseline data do I need?
Ideally at least a year, so you can show whether the problem is stable rather than a short-term fluctuation.