NR 709A Week 3 Baseline to Endpoint Comparison Example

Baseline to Endpoint: The Same Twelve Calendar Weeks of 2026 and 2027, Counted Under One Printed Rule

Student Name

College of Nursing, Chamberlain University

NR 709A: DNP Project & Practicum IV

Instructor Name

Month Day, Year

Baseline to Endpoint: The Same Twelve Calendar Weeks of 2026 and 2027, Counted Under One Printed Rule

The Counting Rule, Printed Once

Every figure in this comparison was counted under the rule below, applied in the same way to 2026 and 2027. The rule was written into the charter before the test began and has not been changed since (Langley et al., 2009).

An eligible patient is an adult aged 18 or older whose recorded PHQ-9 total reached 10 or above during an adult medicine visit here, counted once, at the first such visit in the window. A patient seen by any behavioral health clinician at the health center in the 90 days before that visit is excluded, because they are already in care. The outcome is met when, within 30 days of that visit, the record shows a completed behavioral health visit in person or by video, or a phone contact of ten minutes or more documented by behavioral health staff. Scheduled visits that were missed, and calls that reached voicemail, do not count. Patients who transferred out of the health center within the 30 days stay in the denominator.

Equal Windows From the Same Season

The test ran from Monday 1 March to Monday 24 May 2027, twelve weeks. The comparison window is Monday 2 March to Monday 25 May 2026, the same twelve calendar weeks one year earlier, chosen so that both windows include the same mix of spring visits, the same holiday and the same end of the school term, which affects visit patterns for parents. No run-in period is folded into either window. The weeks of training in February 2027 are outside the test window, as are the corresponding weeks of 2026.

The six-month baseline reported in the proposal, January to June 2026, is longer and includes winter months when screening volumes are higher. It remains the reference for the run chart median, but it is not used for the before-and-after table, because comparing twenty-six winter-and-spring weeks with twelve spring weeks would mix a seasonal difference into the result.

The Comparison Table

Each change is given both as a difference and as a ratio because each hides something the other shows. The same-day row is the clearest case: a gain of fifty points is large, but the ratio of nearly seven tells the reader that same-day contact was rare before, not merely lower. The outcome row works the other way: a ratio of 1.63 sounds modest, but the bases show that it means about 61 more patients reaching care per 298 eligible, which is the figure the health center's board will understand.

The Baseline I Inherited

The proposal's baseline came from the quality analyst's monthly integrated care report, which gave 189 of 580 for January to June 2026. That report was built for a different purpose. It counted every positive screen rather than each patient once, and it counted any behavioral health encounter, including a two-minute phone call that reached voicemail and was logged as an attempt.

For this comparison, the 2026 window was recounted by hand from the record under the printed rule, with the analyst checking a sample of 40 patients. Under the report's original rule, the same twelve weeks gave 101 of 301, 33.6%. Under the project rule, they gave 97 of 298, 32.6%. The two rules differ by three eligible visits and four outcomes, mostly repeat screens in the same patient and short calls. The difference is small, but if the 2027 figure had been counted under the project rule and compared with the report's figure, the gain would have been understated by a point and the comparison would not have been like with like. Run charts for improvement depend on that consistency (Perla et al., 2011).

What Else Happened in Those Months

A single-clinic comparison of two periods cannot pull the handoff apart from whatever else shifted in those months, so each known change is listed here with its likely direction.

From 1 April 2027 the largest payer paid for video sessions with behavioral health staff. Eighteen of the 139 outcome contacts were by video. This could raise the 2027 rate independent of the handoff.

A new family physician joined the site on 12 April 2027 and was trained in the handoff before their first clinic. More clinicians could raise screening volume; in fact, eligible patients per week fell.

The fall in eligible patients per week, from 24.8 to 21.8, appears to come from the 90-day exclusion: more patients were already in behavioral health care in 2027, partly because of the handoff's own success in the first weeks. A patient reached in March and screened again in May is excluded in May. This lowers the denominator in the later weeks and is a side effect of the change rather than an outside event.

Nothing comparable happened at the site in spring 2026, as far as the two clinical leads at the site could recall and the operations meeting minutes show.

Reading the Comparison

The handoff was followed by a gain of about twenty points in 30-day contact, with the change visible in the first four weeks, before the payer change. The size of the gain after April may be partly due to video coverage. Visit length and missed follow-ups moved slightly in the wrong direction but stayed within the limits set in advance. Integrated care trials have shown that embedding behavioral health in primary care can improve access for patients with depression (Unützer et al., 2002), and this comparison is consistent with that body of work, at one site, over one season. A second season, counted under the same printed rule, is the obvious next test, and the handover packet assigns the monthly count to the quality analyst so that test can happen without the student.

References

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895

Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., Harpole, L., Hoffing, M., Della Penna, R. D., Noël, P. H., Lin, E. H. B., Areán, P. A., Hegel, M. T., Tang, L., Belin, T. R., Oishi, S., & Langston, C. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. JAMA, 288(22), 2836-2845. https://doi.org/10.1001/jama.288.22.2836