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Am I making a difference? Measuring dietetic outcomes in clinical practice

European Journal of Clinical Nutrition volume 69, pages 1181–1183 (2015)Cite this article

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The landscape for quality health-care delivery is changing rapidly, demanding innovative, cost-effective and outcome-focussed service models for increasingly complex conditions.1, 2 The advances in knowledge and demands for evidence-based practice govern the need for dietitians to continually evolve their role and monitor outcomes accordingly across broad heterogeneous patient populations, potentially exposed to multidisciplinary treatments.

Our dietetic service for diabetes within a tertiary hospital ambulatory-care setting was being evaluated in preparation for forecasted funding model changes. The aim was to determine what dietetic outcomes were achieved and whether these could withstand changes to service models. An 18-month snapshot of robust indicators such as anthropometry, biochemistry, including HbA1c, medications, hospital admissions, number of appointments and attendance, were retrospectively collected. The statistical analysis proved complex owing to missing data and a heterogeneous patient population with vast idiosyncrasies. For instance, the large variation in previous exposure to medical/dietetic follow-up ranged from 0.08 to 11.15 years. These factors contributed to violations in the assumptions of longitudinal statistical modelling, thereby limiting the exploration of an intervention effect. This was further limited by obvious confounders affecting many of our chosen indicators, for example, commencement of insulin, dialysis and transfusions impacting on HbA1c results. We were unable to account for dietetic intervention outside of our facility, multi-morbidity and other factors such as social circumstances. It was a confronting moment to realise that we had no way to know if we were making a difference with the current service model let alone any alternative models!

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References

  1. Joiner KA, Coleman DL . Perspective: key indicators in academic medicine: a suggested framework for analysis. Acad Med 2012; 87: 230–235.

    Article  Google Scholar 

  2. Jortberg BT, Fleming MO . Registered dietitian nutritionists bring value to emerging health care delivery models. J Acad Nutr Diet 2014; 114: 2017–2022.

    Article  Google Scholar 

  3. Lemon CC, Lacey K, Lohse B, Hubacher DO, Klawitter B, Palta M . Outcomes monitoring of health, behavior, and quality of life after nutrition intervention in adults with type 2 diabetes. J Am Diet Assoc 2004; 104: 1805–1815.

    Article  Google Scholar 

  4. Gardner JK, Rall LC, Peterson CA . Lack of multidisciplinary collaboration is a barrier to outcomes research. J Am Diet Assoc 2002; 102: 65–71.

    Article  Google Scholar 

  5. King C, Byham-Gray L, Parrott JS, O'Sullivan Maillet J, Roberts MM, Splett P . Applying social cognitive career theory to registered dietitian research involvement: a randomized controlled trial. J Allied Health 2014; 43: 201–211.

    PubMed  Google Scholar 

  6. Cant R . What outcome measures do Australian dietitians use to evaluate nutrition education interventions with individual patients? Nutr Diet 2008; 65: 284–291.

    Article  Google Scholar 

  7. Splett P, Myers EF . A proposed model for effective nutrition care. J Am Diet Assoc 2001; 101: 357–363.

    Article  CAS  Google Scholar 

  8. The British Dietetic Association Model for Dietetic Outcomes. BDA: UK, 2011.

  9. Metro South Health. Consumer and Commuity Engagement Strategy. In Queensland Health ed 2012: http://www.health.qld.gov.au/metrosouth/engagement/docs/cce-strategy.pdf.

  10. NHS Modernisation Agency Learning From Patients and Carers Experience: a Guide for Using Discovery Interviews to Improve Care. In: NHS Modernisation Agency (ed): Leicester, England, 2004.

  11. Agarwal E, Ferguson M, Banks M, Bauer J, Capra S, Isenring E . An exploratory study to evaluate whether medical nutrition therapy can improve dietary intake in hospital patients who eat poorly. J Hum Nutr Diet 2013; 26: 538–543.

    Article  CAS  Google Scholar 

  12. Martin AL, Warren JP, Lipman RD . The landscape for diabetes education: results of the 2012 AADE national diabetes education practice survey. Diabetes Educ 2013; 39: 614–622.

    Article  Google Scholar 

  13. Murphy WJ, Steiber AL . A new breed of evidence and the tools to generate it: introducing ANDHII. J Acad Nutr Diet 2015; 115: 19–22.

    Article  Google Scholar 

  14. Copes L, Ramsay K . Using the standardized language for the nutrition care process in the electronic health record to measure and report nutrition care outcomes. J Am Diet Assoc 2010; 110: A86.

    Article  Google Scholar 

  15. Hakel-Smith N, Lewis NM . A standardized nutrition care process and language are essential components of a conceptual model to guide and document nutrition care and patient outcomes. J Am Diet Assoc 2004; 104: 1878–1884.

    Article  Google Scholar 

  16. Lacey K, Pritchett E . Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management. J Am Diet Assoc 2003; 103: 1061–1072.

    Article  Google Scholar 

  17. Yadrick MM, Murphy WJ, Steiber A . Academy of Nutrition and Dietetics Health Informatics Infrastructure Feasibility Testing: first results from a new web-based tool to study nutrition care and outcomes. J Acad Nutr Diet 2014; 114: A43.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia

    I J Hickman, J Cotugno, A-C M Lassemillante & M Ferguson

  2. Mater Research Institute—University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia

    I J Hickman

  3. School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia

    M Ferguson

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  1. I J Hickman
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  2. J Cotugno
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  3. A-C M Lassemillante
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  4. M Ferguson
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Correspondence to I J Hickman.

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Hickman, I., Cotugno, J., Lassemillante, AC. et al. Am I making a difference? Measuring dietetic outcomes in clinical practice. Eur J Clin Nutr 69, 1181–1183 (2015). https://doi.org/10.1038/ejcn.2015.148

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