scholarly journals Perspectives of Registered Dietitian Nutritionists on Adoption of Telehealth for Nutrition Care during the COVID-19 Pandemic

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 235
Author(s):  
Cory Brunton ◽  
Mary Beth Arensberg ◽  
Susan Drawert ◽  
Christina Badaracco ◽  
Wendy Everett ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Healthcare Professionals ◽  
The United States ◽  
Quality Improvement Initiative ◽  
Registered Dietitian ◽  
Care Needs ◽  
Nutrition Care ◽  
Nutrition Programs ◽  
Risk Patients ◽  
Registered Dietitian Nutritionists

Widespread transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a global coronavirus disease 2019 (COVID-19) pandemic that is straining medical resources worldwide. In the United States (US), hospitals and clinics are challenged to accommodate surging patient populations and care needs while preventing further infection spread. Under such conditions, meeting with patients via telehealth technology is a practical way to help maintain meaningful contact while mitigating SARS-CoV-2 transmission. The application of telehealth to nutrition care can, in turn, contribute to better outcomes and lower burdens on healthcare resources. To identify trends in telehealth nutrition care before and during the pandemic, we emailed a 20-question, qualitative, structured survey to approximately 200 registered dietitian nutritionists (RDNs) from hospitals and clinics that have participated in the Malnutrition Quality Improvement Initiative (MQii). RDN respondents reported increased use of telehealth-based care for nutritionally at-risk patients during the pandemic. They suggested that use of such telehealth nutrition programs supported positive patient outcomes, and some of their sites planned to continue the telehealth-based nutrition visits in post-pandemic care. Nutrition care by telehealth technology has the potential to improve care provided by practicing RDNs, such as by reducing no-show rates and increasing retention as well as improving health outcomes for patients. Therefore, we call on healthcare professionals and legislative leaders to implement policy and funding changes that will support improved access to nutrition care via telehealth.

scholarly journals Empowering Health Care Professionals: An Interprofessional Education Model Implementation and Evaluation

2019 ◽  
Author(s):  
Jessica Shank Coviello
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Interprofessional Education ◽  
Healthcare Professionals ◽  
The United States ◽  
Healthcare Systems ◽  
World Health ◽  
Institute Of Medicine ◽  
Care Needs ◽  
Ensure Patient Safety

In 2016, the Institute of Medicine (IOM) reported medical error as the 3rd leading cause of death in healthcare systems in the United States. Effective communication of patient care needs across healthcare disciplines is critical to ensure patient safety, quality of care, and to improve operational efficiencies in healthcare systems. Ineffective collaboration and communication among healthcare professionals within the procedural areas increases the potential of harm as a patient moves from one healthcare professional to another. Health care systems are thus encouraged to train employees with a focus on interprofessional education (IPE) and collaborative practice. IOM and World Health Organization (WHO) recommend the use of IPE to help improve communication and collaboration. However the current educational structure in many institutions does not include IPE. As such, healthcare professionals work in silos, with little or no collaboration with one another, which may result in service duplication, increased service cost, and poor health outcomes for patients.

scholarly journals Malnutrition definitions in clinical practice: To be E43 or not to be?

2019 ◽  
Vol 49 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Wendy Phillips ◽  
Jennifer Doley ◽  
Kelli Boi
Keyword(s):  
United States ◽  
Extended Period ◽  
International Classification Of Diseases ◽  
The United States ◽  
Nutrition Status ◽  
Registered Dietitian ◽  
Classification Of Diseases ◽  
Registered Dietitian Nutritionists ◽  
Medical Record Documentation

Malnutrition is a disease that imposes a significant healthcare cost burden in the United States, especially when left undiagnosed and untreated for an extended period of time. This article discusses traditional malnutrition diagnostic criteria for adults and why registered dietitian nutritionists and physicians should no longer use these criteria to determine nutrition status. It concludes with the malnutrition clinical characteristics currently accepted in the United States and globally, with implications for practice. Clinical documentation specialists and medical coders can use this information to better interpret medical record documentation and assign the correct International Classification of Diseases, 10th Revision, Clinical Modification codes to the coding abstract.

scholarly journals Increased competency of dietitian nutritionists’ physical examination skill after a simulation-based education in the United States

2020 ◽  
Vol 17 ◽  
pp. 40
Author(s):  
Elizabeth L. MacQuillan ◽  
Jennifer Ford ◽  
Kristin Baird
Keyword(s):  
Clinical Skill ◽  
Training Session ◽  
The United States ◽  
Registered Dietitian ◽  
Video Recordings ◽  
Physical Examination Skill ◽  
Simulation Based ◽  
Before And After ◽  
Examination Skill ◽  
Registered Dietitian Nutritionists

Purpose: This study aimed to translate simulation-based dietitian nutritionist education to clinical competency attainment in a group of practicing Registered Dietitian Nutritionists (RDNs). Using a standardized instrument to measure performance on the newly-required clinical skill, Nutrition Focused Physical Exam (NFPE), competence was measured both before and after a simulation-based education (SBE) session. Methods: Total 18 practicing RDNs were recruited by their employer Spectrum Health system. Following a pre-brief session, participants completed an initial 10-minute encounter, performing NFPE on a standardized patient (SP). Next, participants completed a 90-minute SBE training session on skills within NFPE, including hands-on practice and role play, followed by a post-training SP encounter. Video recordings of the SP encounters were scored to assess competence on seven skill areas within the NFPE. Scores were for initial competence and change in competence.. Results: Initial competence rates ranged from 0- 44% of participants across the seven skills assessed. The only competency where participants scored in the “meets expectations” range initially was “approach to the patient(. When raw competence scores were assessed for change from pre- to post-SBE training, a paired t-test indicated significant increased in all seven competency areas following the simulation-based training (P< .001). Conclusion: This study showed the effectiveness of a SBE training for increased competence scores of practicing dietitian nutritionist on a defined clinical skill.

Using palliative care to maximize the value of care for patients with advanced cancer.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 59-59
Author(s):  
Risha Gidwani ◽  
Randall Gale ◽  
Diane E. Meier ◽  
Steven M Asch
Keyword(s):  
Palliative Care ◽  
Patient Outcomes ◽  
Advanced Cancer ◽  
Cancer Care ◽  
Financial Burden ◽  
Medical Costs ◽  
The United States ◽  
Care Patient ◽  
Care Needs ◽  
Patients With Cancer

59 Background: Cancer is one of the highest cost conditions in the United States, with growth in cancer costs outpacing general medical costs. This is troubling from a patient perspective. Patients with cancer experience significantly greater financial burdens compared with patients with other medical conditions. Many patients forgo or discontinue cancer treatment partly because they do not want to burden their families with significant debt. The growth of cancer and other medical costs is also threatening the health of the U.S. economy, prompting calls for the need for high-value practices. In healthcare, value indicates an achievement of patient outcomes proportional to the resources spent to achieve them. Increasing the provision of palliative care may be one way to achieve higher value care in cancer. Methods: We summarize the literature regarding palliative care, patient outcomes, and costs to assess the value of palliative care in advanced cancer. We also review the literature to identify reasons for low patient receipt of palliative care. Results: Palliative care represents a strong opportunity to improve the value of cancer care. Palliative care is associated with better informed and more satisfied patients and families, a reduction in use of undesired medical services, and does not pose a risk of increased mortality. Reasons for low rates of palliative care include a mismatch between how patients perceive palliative care and how physicians believe patients perceive palliative care, a lack of familiarity with locally-available palliative services, and a perceived incompatibility with cancer therapy. Conclusions: Palliative care for patients with cancer can improve the patient and family experience while maximizing value for the healthcare system and averting unnecessary patient financial burden. Systems redesign is needed in order to support oncologists in supporting the palliative care needs of their patients and realizing this high-value cancer care.

scholarly journals Registered Dietitian Nutritionists Are Associated with Improved Long-Term Clinical Outcomes in High-Risk Patients

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1293-1293
Author(s):  
Erika Cavanaugh ◽  
Heather Zeman ◽  
Elizabeth Metallinos-Katsaras ◽  
Shelley Strowman ◽  
Kathy Ireland ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Repeated Measures ◽  
Registered Dietitian ◽  
High Risk Patients ◽  
Significant Difference ◽  
Risk Patients ◽  
Registered Dietitian Nutritionists

Abstract Objectives Treatment from registered dietitian nutritionists (RDNs) has been shown to improve weight and hemoglobin A1c in high-risk patients, yet little is known about these outcomes long term. The current study investigated the association between RDN care and changes in weight and HbA1c compared to primary care in high-risk patients (BMI ≥35 kg/m2 or HbA1c ≥7%) long term up to 24 months. Methods This was a retrospective cohort study of high-risk adults. Electronic medical records were reviewed for participants who were 18 years or older with BMI ≥35 kg/m2 or HbA1c ≥7.0% at first visit to a patient centered medical home in Boston, MA. Mean change in weight (kg) and HbA1c (%) at six, 12, and 24 months were compared between patients who saw an RDN and patients who received primary care only. Paired sample t-tests and repeated measures ANOVA adjusting for age, sex, gender, days from baseline at follow-up visit, and number of clinic visits at follow-up were used to analyze outcomes. Results 1902 patients with BMI &gt;35 and 1240 patients with a HbA1c &gt;7.0% were included. There was no significant difference in 24-month weight loss between RDN care and standard primary care. HbA1c decreased significantly with RDN care at all time points (P &lt; 0.001). Patients with at least one RDN visit had a significantly greater mean change in HbA1c of −0.8 ± 0.2 (95% CI −1.0 to −0.5) and −0.6 ± 0.1 (95% CI −0.8 to −0.3) after 12 and 24 months from baseline, respectively (P &lt; 0.001). Conclusions RDN care resulted in statistically and clinically significant improvements in HbA1c at 12 and 24 months compared to standard primary care alone. Funding Sources The authors received no specific funding for this work.

Clinical Review and Implications of the Guideline for the Early Management of Patients With Acute Ischemic Stroke

2014 ◽  
Vol 25 (2) ◽  
pp. 130-141
Author(s):  
Sarah L. Livesay
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Outcomes ◽  
Healthcare Professionals ◽  
American Heart ◽  
Heart Association ◽  
The United States ◽  
Evidence Based ◽  
Early Management

Stroke is the fourth leading cause of death and the leading cause of significant, long-term disability in the United States. Clinicians’ knowledge and use of evidence to guide the care of patients with ischemic stroke are paramount to improving patient outcomes. The recently updated “Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association” provides clinicians with evidence-based, expert consensus to guide the recognition and early management of patients with acute ischemic stroke. The guideline provides 115 recommendations for the management of patients with acute ischemic stroke, including 24 new recommendations and 51 revised recommendations divided into 14 major topic areas. This article reviews the recommendations and related literature and provides suggestions for use and implementation of the guideline within a stroke program of care.

scholarly journals Identification, Evaluation, and Treatment of Patients with Hereditary Cancer Risk within the United States

ISRN Oncology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Deborah Cragun ◽  
Tuya Pal
Keyword(s):  
United States ◽  
Primary Care ◽  
Genetic Testing ◽  
High Risk ◽  
Cancer Risk ◽  
Patient Outcomes ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Risk Patients

Recognizing the importance of identifying patients at high risk for inherited cancer predisposition, the United States Preventive Services Task Force (USPSTF) has outlined specific family history patterns associated with an increased risk for BRCA mutations. However, national data indicate a need to facilitate the ability of primary care providers to appropriately identify high risk patients. Once a patient is identified as high risk, it is necessary for the patient to undergo a detailed genetics evaluation to generate a differential diagnosis, determine a cost-effective genetic testing strategy, and interpret results of testing. With identification of inherited predisposition, risk management strategies in line with national guidelines can be implemented to improve patient outcomes through cancer risk reduction and early detection. As use of genetic testing increasingly impacts patient outcomes, the role of primary care providers in the identification and care of individuals at high risk for hereditary cancer becomes even more important. Nevertheless it should be acknowledged that primary care providers face many competing demands and challenges to identify high risk patients. Therefore initiatives which promote multidisciplinary and coordinated care, potentially through academic-community partnerships, may provide an opportunity to enhance care of these patients.

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