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Long JM, Yoder A, Woodcock L, Papoutsakis C. Impact of a Registered Dietitian Nutritionist-Led Food as Medicine Program in the Food Retail Setting: A Feasibility Study. J Acad Nutr Diet 2024:S2212-2672(24)00543-4. [PMID: 39004303 DOI: 10.1016/j.jand.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/20/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Food as medicine (FAM) interventions have been associated with improved health outcomes. However, there is limited FAM evidence in food retail settings. OBJECTIVE The objective was to evaluate the feasibility of a registered dietitian nutritionist-led FAM program that aims to detect changes in participants' nutrition problems and related nutrition and health outcomes, as documented by the Nutrition Care Process framework. DESIGN The study was a descriptive feasibility nutrition intervention cohort analysis. PARTICIPANTS SETTING A convenience sample of online food shoppers were enrolled in collaboration with a food retail chain (n = 39 participants completed the intervention and were included in primary analyses). INTERVENTION Participants received nutrition care for 6 months either in person or via telehealth. The FAM intervention included tailored nutrition care that integrated software-generated meal plans and food shopping lists to support online food shopping. MAIN OUTCOME MEASURES Progress of nutrition problems and diet quality (assessed via the Picture your Plate survey) were measured. Measurements included changes in anthropometric and biochemical parameters, blood pressure, and quality of life (assessed via the Centers for Disease Control and Prevention's Health Related Quality of Life-14 survey). STATISTICAL ANALYSES PERFORMED Mann-Whitney U test, Pearson's χ2, and Wilcoxon signed-rank tests were used to detect differences. RESULTS The most prevalent nutrition problems demonstrated improvement rates as follows: excessive energy intake, 81% (n = 21 of 26); excessive carbohydrate intake, 88% (n = 7 of 8); and obesity, 100% (n = 5 of 5). Exposure to the FAM intervention improved dietary quality, quality of life, body weight, waist circumference, and systolic pressure. CONCLUSIONS FAM interventions can be carried out by in-store registered dietitian nutritionists in the supermarket setting. This feasibility study highlighted the need and opportunity for larger studies in which registered dietitian nutritionist-led FAM interventions, in collaboration with food retailers, may improve people's nutrition and health.
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Affiliation(s)
- Julie M Long
- Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Allison Yoder
- Academy of Nutrition and Dietetics Foundation, Chicago, Illinois
| | | | - Constantina Papoutsakis
- Data Science Center, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois.
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2
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Hickson M, Papoutsakis C, Madden AM, Smith MA, Whelan K. Nature of the evidence base and approaches to guide nutrition interventions for individuals: a position paper from the Academy of Nutrition Sciences. Br J Nutr 2024; 131:1754-1773. [PMID: 38305040 DOI: 10.1017/s0007114524000291] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
This Position Paper from the Academy of Nutrition Sciences is the third in a series which describe the nature of the scientific evidence and frameworks that underpin nutrition recommendations for health. This paper focuses on evidence which guides the application of dietary recommendations for individuals. In some situations, modified nutrient intake becomes essential to prevent deficiency, optimise development and health, or manage symptoms and disease progression. Disease and its treatment can also affect taste, appetite and ability to access and prepare foods, with associated financial impacts. Therefore, the practice of nutrition and dietetics must integrate and apply the sciences of food, nutrition, biology, physiology, behaviour, management, communication and society to achieve and maintain human health. Thus, there is huge complexity in delivering evidence-based nutrition interventions to individuals. This paper examines available frameworks for appraising the quality and certainty of nutrition research evidence, the development nutrition practice guidelines to support evidence implementation in practice and the influence of other sources of nutrition information and misinformation. The paper also considers major challenges in applying research evidence to an individual and suggests consensus recommendations to begin to address these challenges in the future. Our recommendations target three groups; those who deliver nutrition interventions to individuals, those funding, commissioning or undertaking research aimed at delivering evidence-based nutrition practice, and those disseminating nutritional information to individuals.
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Affiliation(s)
- Mary Hickson
- University of Plymouth, Plymouth, PL4 6ABDevon, UK
- British Dietetic Association, Birmingham, UK
| | - Constantina Papoutsakis
- Academy of Nutrition and Dietetics, Nutrition and Dietetics Data Science Centre, Research, International, and Scientific Affairs (RISA), Chicago, USA
| | | | | | - Kevin Whelan
- King's College London, Department of Nutritional Sciences, London, UK
- Academy of Nutrition Sciences, London, UK
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3
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Aurélien C, Isabelle C, Ludivine S. Evaluation of the nutrition care process documentation in the patients' records using the Diet-NCP-Audit: experience in a medium-sized multi-site Swiss hospital. J Hum Nutr Diet 2024; 37:593-600. [PMID: 38268332 DOI: 10.1111/jhn.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/31/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The nutrition care process (NCP) is a four-step systematic approach to guide dietitians in providing high-quality nutrition care. It fosters critical thinking and enhances the consistency of dietitians' documentation. Following international recommendations, University Training Hospital of Fribourg (HFR) implemented it in 2013. This study aimed to evaluate the quality of NCP documentation in electronic patient records (EPRs) and to determine the nutrition problems dietitians most often identified while documenting their actions. METHODS The audit was performed on 92 EPRs using the Diet-NCP-Audit, which was translated into French for this study. RESULTS The documentation quality was assessed as high in 62% of the EPRs, and nutrition diagnoses were mostly documented. In half of the EPRs, nutrition assessment (step 1 of the NCP) was inconsistent with nutrition diagnosis (step 2). Dietitians often used the same nutrition problems: out of the 73 nutrition problems defined in NCP terminology, only 4 (5%) represented 58% of the 189 problems identified in the EPR audit. CONCLUSION EPRs were mostly assessed as high quality. However, the entire process requires improved consistency. The poorly documented link between the NCP steps and the restricted choices of nutrition problems dietitians identified should be addressed because they could reveal that dietitians have not fully adopted critical thinking, which the NCP stresses.
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Affiliation(s)
- Clerc Aurélien
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- Department of Nutrition and Dietetics, University Training Hospital of Fribourg (HFR), Fribourg, Switzerland
| | - Carrard Isabelle
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
| | - Soguel Ludivine
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- Department of Teaching, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
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Lewis S, Miranda L, Kurtz J, Brewer WJ, Papoutsakis C. Harnessing the Benefits of the Nutrition Care Process Quality Evaluation and Standardization Tool: A National Auditing Initiative to Improve Quality of Documentation. J Acad Nutr Diet 2023; 123:1662-1668. [PMID: 37422056 DOI: 10.1016/j.jand.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
The Nutrition Care Process Quality Standardization and Evaluation Tool (NCP QUEST) is a validated audit instrument assessing the quality of NCP documentation by registered dietitian nutritionists. The present quality improvement project describes change in documentation quality as measured by NCP QUEST and word count of notes after a monthly national digital training provided to Veterans Affairs registered dietitian nutritionists. The training and adoption of NCP QUEST was voluntary. Facilities were recruited among those that had participated during the design and validation study of NCP QUEST. The NCP QUEST score was calculated and the word count was determined for 52 documentation notes (28 from NCP QUEST nonuser facilities and 24 from NCP QUEST user facilities) before and after training. The mean pretraining NCP QUEST score for notes from NCP QUEST nonuser facilities was 13.71 and 13.88 for NCP QUEST user facilities. The mean posttraining total NCP QUEST score for nonuser facilities was 14.00 and 17.65 for user facilities, with no improvement for the nonuser facilities (P = 0.69). A significant improvement was identified for the NCP QUEST user facilities (P ≤ 0.001). All facilities experienced a significant reduction in the word count of assessment notes (P = 0.04). Use of the electronic NCP Terminology website increased 123-fold and was sustained after the training. NCP QUEST users reported that the audit tool is useful. The NCP QUEST should be at the center of registered dietitian nutritionists' training and more strategic effort is needed to engage practitioners in the optimal application of the NCP.
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Affiliation(s)
| | | | - Julie Kurtz
- Phoenix VA Health Care System, Phoenix, Arizona
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5
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Heitman K, Proaño GV, Papoutsakis C, Diaque Ballesteros P, Steiber A, Taylor CA. Learning Outcomes From a Virtual Nutrition Care Process Workshop Delivered to Nutrition and Dietetics Professionals in Mexico. TOP CLIN NUTR 2023. [DOI: 10.1097/tin.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Colin CR, Woodcock L, Wright LY, Yakes Jimenez E, Papoutsakis C. The Need for and Challenges of Nutrition and Dietetics Registry Studies: An Update on the Academy of Nutrition and Dietetics Health Informatics Infrastructure. J Acad Nutr Diet 2023; 123:673-682. [PMID: 36623691 DOI: 10.1016/j.jand.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Casey R Colin
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | | | - Lauri Y Wright
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | - Elizabeth Yakes Jimenez
- Academy of Nutrition and Dietetics, Chicago, Illinois; Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico; College of Population Health, University of New Mexico, Albuquerque, New Mexico
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Colin C, Arikawa A, Lewis S, Cooper M, Lamers-Johnson E, Wright L, Papoutsakis C. Documentation of the evidence-diagnosis link predicts nutrition diagnosis resolution in the Academy of Nutrition and Dietetics' diabetes mellitus registry study: A secondary analysis of Nutrition Care Process outcomes. Front Nutr 2023; 10:1011958. [PMID: 36969819 PMCID: PMC10034103 DOI: 10.3389/fnut.2023.1011958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
ObjectivesTo describe nutrition care documentation patterns and investigate predictors of nutrition diagnosis resolution.MethodsThis is a secondary data analysis of a 2-year pragmatic, quasi-experimental study conducted in outpatient clinics where nutrition care was provided to adults with diabetes Type 1 or 2 from May 2017 to June 2019 (n = 564 patients). The main outcome measures were frequency of standardized Nutrition Care Process (NCP) terms, NCP links, nutrition diagnosis resolution and predictors of nutrition diagnosis resolution. Predictors of diagnosis resolution were identified using a multivariable logistic regression model.ResultsThe most prevalent resolved diagnoses were excessive carbohydrate intake (32%), undesirable food choices (21%) and excessive energy intake (13%). The top etiology was food and nutrition related knowledge deficit (57%) and interventions were drawn mainly from the Nutrition Education domain (64%). One hundred forty-six patient cases (26%) had at least one follow-up visit and 26% of those with a follow-up (n = 38) had a resolved diagnosis. The presence of the evidence-diagnosis NCP link in documentation predicted diagnosis resolution (OR = 2.80, 95% CI 1.30–6.02; p = 0.008).ConclusionMost diagnoses were caused by patients' lack of knowledge and respective interventions focused on nutrition education. Odds of diagnosis resolution improved when the signs and symptoms of the diagnosis were documented during assessment (evidence-diagnosis NCP link). Training dietitians on NCP links may be important to resolve nutrition diagnoses. Presented findings are hypothesis generating.
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Affiliation(s)
- Casey Colin
- Department of Nutrition & Dietetics, University of North Florida, Jacksonville, FL, United States
| | - Andrea Arikawa
- Department of Nutrition & Dietetics, University of North Florida, Jacksonville, FL, United States
| | - Sherri Lewis
- James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Melissa Cooper
- Department of Nutrition & Dietetics, University of North Florida, Jacksonville, FL, United States
| | | | - Lauri Wright
- Department of Nutrition & Dietetics, University of North Florida, Jacksonville, FL, United States
| | - Constantina Papoutsakis
- Academy of Nutrition and Dietetics, Chicago, IL, United States
- *Correspondence: Constantina Papoutsakis
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8
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Al‐Adili L, Boström A, Orrevall Y, Lang NR, Peersen C, Persson I, Thoresen L, Lövestam E. Self‐reported documentation of goals and outcomes of nutrition care – A cross‐sectional survey study of Scandinavian dietitians. Scand J Caring Sci 2022; 37:472-485. [PMID: 36329640 DOI: 10.1111/scs.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/05/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The documentation of goals and outcomes of nutrition care in Electronic Health Records is insufficient making further exploration of this of particular interest. Identifying common features in documentation practice among Scandinavian dietitians might provide information that can support improvement in this area. AIMS To explore the associations between clinical dietitians' self-reported documentation of patients' goals and outcomes and demographic factors, self-reported implementation of the systematic framework the Nutrition Care Process 4th step (NCP) and its associated terminology, and factors associated with the workplace. METHODS Data from a cross-sectional study based on a previously tested web-based survey (INIS) disseminated in 2017 to dietitians in Scandinavia (n = 494) was used. Respondents were recruited through e-mail lists, e-newsletters and social media groups for dietitians. Associations between countries regarding the reported documentation of goals and outcomes, implementation levels of the NCP 4th step, demographic information and factors associated with the workplace were measured through Chi-square test. Associations between dependent- and independent variables were measured through logistic regression analysis. RESULTS Clinically practicing dietitians (n = 347) working in Scandinavia, Sweden (n = 249), Norway (n = 60), Denmark (n = 38), who had completed dietetic education participated. The reported documentation of goals and outcomes from nutrition intervention was highly associated with the reported implementation of NCP 4th step terminology (OR = 5.26; p = 0.009, OR = 3.56; p = 0.003), support from the workplace (OR = 4.0, p < 0.001, OR = 8.89, p < 0.001) and area of practice (OR = 2.02, p = 0.017). Years since completed dietetic training and educational level did not have any significant associations with documentation practice regarding goals and outcomes. CONCLUSION Findings highlight strong associations between the implementation of the NCP 4th step terminology and the documentation of goals and outcomes. Strategies to support dietitians in using standardized terminology and the development of tools for comprehensive documentation of evaluation of goals and outcome are required.
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Affiliation(s)
- Lina Al‐Adili
- Department of Food Studies, Nutrition and Dietetics Uppsala University Uppsala Sweden
| | - Anne‐Marie Boström
- Department of Neurobiology, Care Science and Society Division of Nursing, Karolinska Institutet Huddinge Sweden
- Theme Inflammation and Aging Karolinska University Hospital Huddinge Sweden
- Research and Development Unit Stockholms Sjukhem Stockholm Sweden
- Karolinska Institutet Huddinge Sweden
| | - Ylva Orrevall
- Department of Biosciences and Nutrition Karolinska Institute Stockholm Sweden
- Medical Unit Clinical Nutrition Women's Health and Allied Health Professionals Theme, Karolinska University Hospital Stockholm Sweden
| | - Nanna R. Lang
- Department of Nutrition and Health VIA University College Denmark
| | - Charlotte Peersen
- Department of Unit for Service and Intern Control Department of Service and Quality, Trondheim Municipality Trondheim Norway
| | - Inger Persson
- Department of Statistics Uppsala University Uppsala Sweden
| | - Lene Thoresen
- Cancer Clinic, St. Olavs Hospital Trondheim University Hospital Trondheim Norway
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics Uppsala University Uppsala Sweden
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9
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Proaño GV, Papoutsakis C, Lamers-Johnson E, Moloney L, Bailey MM, Abram JK, Kelley K, Steiber A, McCabe GP, Myaskovsky L, Jimenez EY. Evaluating the Implementation of Evidence-based Kidney Nutrition Practice Guidelines: The AUGmeNt Study Protocol. J Ren Nutr 2022; 32:613-625. [PMID: 34728124 PMCID: PMC9733590 DOI: 10.1053/j.jrn.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 12/13/2022] Open
Abstract
Evidence-based nutrition practice guidelines (EBNPGs) inform registered dietitian nutritionist (RDN) care for patients with chronic kidney disease grade 5 treated by dialysis; however, there has been little evaluation of best practices for implementing EBNPGs. In this effectiveness-implementation hybrid study with a quasi-experimental design, United States RDNs in hemodialysis clinics will document initial and follow-up nutrition care for patients with chronic kidney disease grade 5 treated by dialysis using the Academy of Nutrition and Dietetics Health Informatics Infrastructure before and after being randomly assigned to a training model: (1) EBNPG knowledge training or (2) EBNPG knowledge training plus an implementation toolkit. The aims of the study include examining congruence of RDN documentation of nutrition care with the EBNPG; describing common RDN-reported EBNPG acceptability, adoption, and adaptation issues; and determining the feasibility of estimating the impact of RDN care on nutrition-related patient outcomes. The AUGmeNt study can inform effective development and implementation of future EBNPGs. Keywords: Chronic kidney diseases; medical nutrition therapy; implementation science; clinical practice guideline; nutrition care process terminology; dietitian.
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Affiliation(s)
- Gabriela V Proaño
- Senior Research Project Manager, Academy of Nutrition and Dietetics, Chicago, Illinois.
| | | | | | - Lisa Moloney
- Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Mary M Bailey
- Research Consultant, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Jenica K Abram
- Manager, Nutrition Research Network, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Kathryn Kelley
- Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Alison Steiber
- Chief Science Officer, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - George P McCabe
- Professor Emeritus of Statistics, Purdue University, West Lafayette, Illinois
| | - Larissa Myaskovsky
- Professor, Department of Internal Medicine, Director, Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Elizabeth Yakes Jimenez
- Research Associate Professor, Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Director, Nutrition Research Network, Academy of Nutrition and Dietetics, Albuquerque, New Mexico
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10
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Braun A, Hill E, Gallo S, Landry MJ, Vitolins M, Papoutsakis C, Jimenez EY, Rozga M. Research at the Academy of Nutrition and Dietetics: What, How, and Why? J Acad Nutr Diet 2022; 122:2150-2162. [PMID: 35998865 DOI: 10.1016/j.jand.2022.08.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 10/31/2022]
Abstract
Research is essential to further advance our understanding of the role of nutrition and dietetics in maintenance and improvement of health. Research is also essential for nutrition and dietetics professionals to create and provide evidence-based interventions, including medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs). Given this critical role of research, the Academy of Nutrition and Dietetics (Academy) has a variety of resources to assist its members in accessing, understanding, participating in, conducting, and disseminating nutrition research. These resources are comprehensive and include opportunities to participate in research (e.g., Nutrition Research Network (NRN) and Data Science Center (DSC)), tools to aggregate practice data (Nutrition Care Process and Terminology (NCPT) and the Academy of Nutrition and Dietetics Informatics Infrastructure (ANDHII)), funding opportunities to support primary research (e.g., Academy Foundation), resources to understand the latest research informing evidence-based practice (EBP) (e.g., Evidence Analysis Center (EAC)), and avenues for sharing research findings (e.g., Food and Nutrition Conference and Expo (FNCE)). The aim of this paper is to encourage members to get involved in research by describing Academy-based research resources and opportunities to contribute to nutrition and dietetics research, as well as describe specific examples of research conducted at Academy. The information presented can serve as a framework to guide members in engaging in research through the Academy.
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Affiliation(s)
- Ashlea Braun
- Assistant Professor, Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University, 312 Nancy Randolph Davis, Stillwater, OK 74078-6141.
| | - Emily Hill
- Postdoctoral Fellow, Department of Pediatrics, Section of Nutrition, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Mailstop F-561 Aurora, CO 80045.
| | - Sina Gallo
- Associate Professor, Nutritional Sciences, University of Georgia, 305 Sanford Drive, suite 209, Athens, GA 30602.
| | - Matthew J Landry
- Postdoctoral Fellow, Stanford Prevention Research Center, School of Medicine, Stanford University, 3180 Porter Drive, Palo Alto, CA 94304.
| | - Mara Vitolins
- Professor, Wake Forest School of Medicine, Department of Epidemiology and Prevention, Medical Center Boulevard, Winston-Salem, NC 27157.
| | - Constantina Papoutsakis
- Senior Director, Nutrition and Dietetics Data Science Center, Research, International and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995.
| | - Elizabeth Yakes Jimenez
- Director, Nutrition Research Network, Academy of Nutrition and Dietetics , 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995, Research Associate Professor, Departments of Pediatrics and Internal Medicine and College of Population Health , University of New Mexico Health Sciences Center , 2211 Lomas Blvd NE, Albuquerque, NM 87106.
| | - Mary Rozga
- Nutrition Researcher II, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995.
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11
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Lewis SL, Miranda LS, Kurtz J, Larison LM, Brewer WJ, Papoutsakis C. Nutrition Care Process Quality Evaluation and Standardization Tool: The Next Frontier in Quality Evaluation of Documentation. J Acad Nutr Diet 2021; 122:650-660. [PMID: 34463620 DOI: 10.1016/j.jand.2021.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/28/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Documentation is essential for communicating care between credentialed nutrition and dietetics practitioners and other health care providers. A validated tool that can evaluate quality documentation of the Nutrition Care Process (NCP) encounter, including progress on outcomes is lacking. The aim of the NCP Quality Evaluation and Standardization Tool (QUEST) validation study is to revise an existing NCP audit tool and evaluate it when used within US Veterans Affairs in all clinical care settings. Six registered dietitian nutritionists revised an existing NCP audit tool. The revised tool (NCP-QUEST) was analyzed for clarity, relevance, and reliability. Eighty-five documentation notes (44 initial, 41 reassessment) were received from eight volunteer Veterans Affairs sites. Five of six registered dietitian nutritionists participated in the interrater reliability testing blinded to each other's ratings; and two registered dietitian nutritionists participated in intrarater reliability reviewing the same notes 6 weeks later blinded to the original ratings. Results showed moderate levels of agreement in interrater reliability (Krippendorff's α = .62 for all items, .66 for total score, and .52 for quality category rating). Intrarater reliability was excellent for all items (α = .86 to .87 for all items; .91 to .94 for total score and.74 to .89 for quality category rating). The NCP-QUEST has high content validity (Content Validity Index = 0.78 for item level, and 0.9 for scale level) after two cycles of content validity review. The tool can facilitate critical thinking, improved linking of NCP chains, and is a necessary foundation for quality data collection and outcomes management. The NCP-QUEST tool can improve accuracy and confidence in charting.
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12
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Al-Adili L, Orrevall Y, McGreevy J, Nydahl M, Boström AM, Lövestam E. Discrepancy in the evaluation of explicit and implicit nutrition care outcomes for patients at risk of malnutrition: A qualitative study. J Hum Nutr Diet 2021; 35:494-503. [PMID: 34231280 DOI: 10.1111/jhn.12931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition. METHODS Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes. RESULTS The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients' subjective perceptions and experiences of their health and described as difficult to measure. CONCLUSIONS Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.
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Affiliation(s)
- Lina Al-Adili
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Ylva Orrevall
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.,Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jenny McGreevy
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Region Sörmland, Eskilstuna, Sweden.,Department of Dietetics, Nykoping Hospital, Nykoping, Sweden
| | - Margaretha Nydahl
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden.,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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Maduri C, Sabrina Hsueh PY, Li Z, Chen CH, Papoutsakis C. Applying Contemporary Machine Learning Approaches to Nutrition Care Real-World Evidence: Findings From the National Quality Improvement Data Set. J Acad Nutr Diet 2021; 121:2549-2559.e1. [PMID: 33903081 DOI: 10.1016/j.jand.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
Using real-world data from the Academy of Nutrition and Dietetics Health Informatics Infrastructure, we use state-of-the-art clustering techniques to identify 2 phenotypes characterizing the episodes of nutrition care observed in the National Quality Improvement (NQI) registry data set. The 2 phenotypes identified from recorded Nutrition Care Process data in the NQI exhibit a strong correspondence with the clinical expertise of registered dietitian nutritionists. For one of these phenotypes, it was possible to implement state-of-the-art classification techniques to predict the nutrition problem-resolution status of an episode of care. Prediction results show that the assessment of nutrition history, number of recorded visits in the episode, and use of nutrition counseling interventions were significantly and positively correlated with problem resolution. Meanwhile, evaluations of nutrition history that were not within the desired ranges were significantly and negatively correlated with problem resolution. Finally, we assess the usefulness of the current NQI data set and data model for supporting the application of contemporary machine learning methods to the data set. We also suggest ways of enhancing the NQI since registered dietitian nutritionists are encouraged to continue to contribute patient cases in this and other registry nutrition studies.
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Affiliation(s)
- Chandramouli Maduri
- Watson Health Foundational Technology, IBM Cloud and Cognitive Software, Yorktown Heights, NY
| | - Pei-Yun Sabrina Hsueh
- Center for Computational Health, IBM T.J. Watson Research Center, Yorktown Heights, NY
| | - Zhiguo Li
- Center for Computational Health, IBM T.J. Watson Research Center, Yorktown Heights, NY
| | - Ching-Hua Chen
- Center for Computational Health, IBM T.J. Watson Research Center, Yorktown Heights, NY
| | - Constantina Papoutsakis
- Nutrition and Dietetics Data Science Center, Research International and Scientific Affairs with the Academy of Nutrition and Dietetics, Chicago, IL.
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Ansu V, Papoutsakis C, Gletsu-Miller N, Spence LA, Kelley K, Woodcock L, Wallace TC, Steiber A. Nutrition care practice patterns for patients with COVID-19-A preliminary report. JPEN J Parenter Enteral Nutr 2021; 45:1774-1778. [PMID: 33728687 PMCID: PMC8250241 DOI: 10.1002/jpen.2106] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 is a respiratory virus that poses risks to the nutrition status and survival of infected patients, yet there is paucity of data to inform evidence‐based quality care. Methods We collected data on the nutrition care provided to patients with coronavirus disease 2019 (COVID‐19) by registered dietitian nutritionists (RDNs). Results Hospitalized COVID‐19 patients (N = 101) in this cohort were older adults and had elevated body mass index. The most frequent nutrition problems were inadequate oral intake (46.7%), inadequate energy intake (18.9%), and malnutrition (18.4%). These problems were managed predominantly with enteral nutrition, food supplements, and multivitamin‐multimineral supplement therapy. Over 90% of documented problems required a follow‐up. Conclusion This data set is the first of its kind to report on the types of nutrition diagnoses and interventions for COVID‐19 cases used by RDNs and highlights the need for increased and continued nutrition care.
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Affiliation(s)
- Velarie Ansu
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | | | - Nana Gletsu-Miller
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Lisa A Spence
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Kathryn Kelley
- Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | | | - Taylor C Wallace
- Think Healthy Group, Washington, District of Columbia, USA.,Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA.,Center for Magnesium Education & Research, Pahoa, Hawaii, USA
| | - Alison Steiber
- Academy of Nutrition and Dietetics, Chicago, Illinois, USA.,Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, USA
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15
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Etiology Intervention Link Predicts Resolution of Nutrition Diagnosis: A Nutrition Care Process Outcomes Study from a Veterans' Health Care Facility. J Acad Nutr Diet 2020; 121:1831-1840. [PMID: 32732152 DOI: 10.1016/j.jand.2020.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022]
Abstract
In this article, we evaluate relationships between Nutrition Care Process (NCP) chain links and improvement or resolution of the nutrition diagnosis. We conducted a retrospective record review for 12 months in a single Veterans Health Administration health care system using the Veterans Health Administration-specific monitoring and evaluation terms, NCP terminology, and its etiology categories to evaluate outcomes. Logistic regression analysis revealed that the strongest predictor for diagnosis improvement was the etiology-intervention link. The odds of improving the nutrition diagnosis were 51.43 times higher when the etiology-intervention link was present. The odds of improving the nutrition diagnosis were 19.74 times higher when the evidence-diagnosis link was present and 9.46 times higher when the intervention-goal link was present. For every added nutrition visit by the registered dietitian nutritionist, the odds of improving the nutrition diagnosis increased by 32.5%. For every increased point on the NCP audit score, the odds of resolving or improving the nutrition diagnosis increased by 37.7%. When applying the NCP, the presence of the etiology-intervention link significantly improves the odds of resolving the nutrition diagnosis in a Veterans Health Administration population. For the first time, we show evidence that the NCP works as designed. Also, we demonstrate that the quality of NCP documentation impacts resolution of the diagnosis, and we describe the methodology for how to evaluate NCP outcomes. Registered dietitian nutritionists are encouraged to critically evaluate links of the NCP chain, assess NCP documentation for quality, and pursue follow-up visits to improve resolution of nutrition problems.
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