Effectiveness Of Medical Nutrition Therapy Research Articles

Changes in Clinical Dietetics Due to Cost Reduction in Healthcare Systems

: Cost reduction in healthcare systems may impact job design of clinical dietitians. Objectives of this qualitative study were to: (1) gather clinical dietetic experts' observations on clinical dietetic job changes, (2) identify visions to improve the professional level of medical nutrition therapy practice, (3) make recommendations on how to prepare students for improved practice, and (4) develop a questionnaire for a quantitative survey. An open-ended questionnaire was designed and sent to nominated clinical dietetic experts in eight states: ND, SD, ME, MN, IA, MO, WI, MI. Responses were sorted into meaningful groups. Selected clinical dietetic experts were interviewed by telephone to clarify their responses.Results indicated changes in staffing and clinical dietitians* activities. In some cases, numbers of clinical dietitians and managers decreased with an increased number of dietetic technicians. In other cases, clinical dietitians' numbers increased to meet increased service needs. Caseloads have changed to include more high-risk patients and outpatients. Results also showed redistribution of activities, efforts to decrease expenses and increase revenue, and changes in department structure and accountability. Suggestions for improving the professional level of dietetic practice included increasing clinical dietitians' capabilities and visibility, proving effectiveness of medical nutrition therapy, and strengthening financial status of dietetic services. Recommendations for educational preparation were increasing student awareness about all aspects of clinical dietitians' jobs (i.e., psychological and behavioral aspects of patients), expanding courses in didactic education, and improving internship programs (i.e., longer duration, more hands-on experiences). Results are the basis for a quantitative questionnaire developed to be field tested with a representative sample of clinical dietitians.

The effect of medical nutrition therapy on malnutrition and clinical outcomes.

Malnutrition is a significant problem in health care today, not only in the United States, but across the world. It has long been known, but underappreciated, that malnutrition is associated with increased mortality, more complications, and longer hospital length of stay (LOS), which lead to an increase in health care costs.1 Substantial evidence exists that medical nutrition therapy saves lives and reduces morbidity and that nutrition support improves health outcomes and lowers costs.2 The purpose of this article is to update the review of literature on malnutrition and the benefit of enteral nutrition support interventions since publication of a definitive article on the same subject in 1996.3

Demonstrating the Effectiveness of Medical Nutrition Therapy

Demonstrating the Effectiveness of Medical Nutrition Therapy

Beneficial Lipid Outcome of Medical Nutrition Therapy for Men with Combined Hyperlipidemia in an Ambulatory Setting

LEARNING OUTCOME: To quantify the effect of medical nutrition therapy in men with combined hyperlipidemia in an ambulatory setting We asked if medical nutrition therapy (MNT) by registered dietitians could lead to a beneficial clinical outcome in men diagnosed with combined hyperlipidemia (hypercholesterolemia and hypertriglyceridemia) [CHL]. We conducted a retrospective chart review of 73 men diagnosed with CHL who were being considered for a lipid lowering drug study. Subjects participated in an 8-week nutrition intervention program as a qualifying requirement prior to initiating pravastatin therapy. Patient records were reviewed to determine the beginning and ending plasma lipid concentrations and the number and length of dietitian sessions. Complete information was available on 43 subjects, mean±SD 60.7±10.1 years. Total dietitian intervention time was 168.8±18.5 minutes in 2.7±0.6 sessions (range=2 to 4) during 6.5±2.2 weeks of MNT (range=4 to 8 weeks). MNT lowered total cholesterol (T-C) 11%, low density lipoprotein cholesterol (LDL-C) 9%, triglyceride (TG) 22% and body mass index (BMI) 2% and raised high density lipoprotein cholesterol (HDL-C) 4%. Pre and post treatment lipids were: T-C 259.5±36.6 vs 230.7±36.2 mg/dl (p<0.001); LDL-C 171.0±29.6 vs 147.1±33.6 mg/dl (p<0.001), TG 368.0±182.3 vs 268.0±142 mg/dl (p<0.001), HDL-C 32.7±8.3 vs 33.4±8.0 mg/dl (NS) and T-C/HDL-C ratio 8.35±2.05 vs 7.23±1.79 (p<0.0001). Based on the National Cholesterol Education Program treatment guidelines algorhythm, 50% (30 vs 15) were no longer eligible for a cholesterol lowering medication post treatment. Not including the cost of monitoring, the direct cost savings (in 1997 dollars) from discontinuing pravastatin eligibility for 6.5 weeks was $40.50 on a per case basis or $324.85 annually. For the entire sub-group (n=15) the annual cost savings is $4,872.75. We conclude that 3 individualized dietitian visits of 56 minutes/visit over 7 weeks has a beneficial effect in treating patients with combined hyperlipidemia.

Cost Effectiveness of Medical Nutrition Therapy Provided by Dietitians for Persons With Diabetes Mellitus

LEARNING OUTCOME: The economic impact of Medical Nutrition Therapy resulting from improving the nutritional status of patients with diabetes mellitus. Medical Nutrition Therapy (MNT) proves to be more cost effective by providing alternatives to more costly therapies. With increased emphasis on cost containment it is important for the Registered Dietitian to show MNT intervention is cost effective. Ten patients with diabetes mellitus, aged 17-75 years, who had been physician referred for MNT were randomly selected. Their medical records were reviewed to determine height, weight, blood glucose, current medications and general health. Nutrition intervention designed to improve glycemic control included portion control, constant carbohydrate counting and general principles of nutrition management. Follow-up phone calls were made to patients and/or physicians 4-6 months after MNT intervention to obtain current clinical outcomes. Patients who had been admitted to long term care were excluded from this study because of their inability to effect behavioral changes in a controlled environment. Costs were established through an average of actual current hospital/physicians and pharmacy charges that patients would have incurred. Positive health outcomes included increased nutritional status resulting in weight loss, decreased blood sugars, improved diet, and increased exercise levels. The average annual cost savings per Type II diabetic patient was $4,145, for Type I patient $9,990 and projected annual cost saving for patients with renal insufficiency $60,958. The average cost per patient for MNT was $41. Savings per case were annual net saving (cost of alternative therapy minus cost of dietitian services). Findings suggest substantial monetary savings, and improved quality of life can be achieved by MNT. Dietetic professionals are key members of the health care team and can play an aggressive roll in controlling health care expenses.

Nutrition Evaluation and Assessment of Patient Care. Quarterly Outcome Analysis for Diabetes Mellitus

LEARNING OUTCOME: To evaluate and assess the effectiveness of medical nutrition therapy on glycohemoglobin levels and weight changes in patients referred for diabetes after at least two nutrition counseling sessions over a six-month period. Patients with diabetes comprise a large number of people seen at the outpatient nutrition center of a major teaching hospital. This study examines glycohemoglobin and weight changes in patients with diabetes who had at least two nutrition visists within a six-month period. Analyses were performed in June, September, December and March of each year for patients who attended initial appointments during one month, six months prior. Data collected was initial and final weights, lab values, cost of services, the number of visits, total time spent with the nutritionist, and relevant medications patients were taking. The number of patients experiencing a positive change was recorded, the percent of change, and the cost for this amount of change. Seven quarters have been completed. Forty-two patients returned for a followup visit. Lab data on glycohemoglobin was incomplete for eleven patients. Twenty-seven patients or 87 percent decreased glycohemoglobin levels. Sixty percent or 25 of the 42 lost weight. Of the 27 patients taking hypoglycemic medication, eight or 30 percent decreased medication dose. The average cost for decreasing glycohemoglobin levels was $161. Medical nutrition therapy is effective in decreasing glycohemoglobin levels and weight in patients with diabetes mellitus and is cost effective. Further studies could compare the effectiveness of one nutrition visit versus further followup on the above indices.

Effectiveness of Medical Nutrition Therapy Provided by Dietitians in the Management of Non–Insulin-Dependent Diabetes Mellitus: A Randomized, Controlled Clinical Trial

Objective To assess the the effect of medical nutrition therapy (MNT) provided by dietitians on medical and clinical outcomes for adults with non–insulin-dependent diabetes mellitus (NIDDM), and to compare MNT administered according to practice guidelines nutrition care (PGC) to MNT administered with basic nutrition care (BC).Design A prospective, randomized, controlled clinical trial of two levels of MNT on metabolic control in persons newly diagnosed with or currently under treatment for NIDDM was conducted at diabetes centers in three states (Minnesota, Florida, and Colorado). BC consisted of a single visit with a dietitian; PGC involved an initial visit with a dietitian followed by two visits during the first 6 weeks of the study period. Data were collected at entry to the study and at 3 and 6 months.Subjects Results are reported for 179 men and women aged 38 to 76 years: 85 assigned randomly to BC and 94 to PGC. This represents 72% of the 247 subjects enrolled. An additional 62 adults with NIDDM at one site who had no contact with a dietitian were identified as a nonrandom comparison group.Outcomes Medical outcome measures included fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and serum lipid levels. Clinical outcomes included weight, body mass index, waist-to-hip ratio, and changes in medical therapy.Statistical analyses Initial analysis of the discrete variables was done using the χ2 statistic with Yates' correction. Initial analysis of continuous variables was done by analysis of variance. The changes in variables between time periods were analyzed by paired t test, and comparisons between groups were analyzed using a t test for independent groups.Results At 6 months, PGC resulted in significant improvements in blood glucose control as indicated by FPG and HbA1c levels and BC resulted in significant improvements in HbA1c level. Participants assigned to the PGC group had a mean FPG level at 6 months that was 10.5% lower than the level at entry, and those in the BC group had a 5.3% lower value. Among subjects who had diabetes for longer than 6 months, those who received PGC had a significantly better HbA1c level at 3 months compared with those receiving BC. The comparison group showed no improvement in glycemic control over a comparable 6 months. PGC subjects had significant improvements in cholesterol values at 6 months, and subjects in both the PGC and the BC groups had significant weight loss.Conclusions MNT provided by dietitians resulted in significant improvements in medical and clinical outcomes in both the BC and PGC groups and is beneficial to persons with NIDDM. Persons with a duration of diabetes longer than 6 months tended to do better with PGC than with BC. Because of the upward trend in glucose levels after 3 months, ongoing MNT by dietitians is important for long-term metabolic control. J Am Diet Assoc. 1995; 95:1009-1017.

Beneficial Effect of Medical Nutrition Therapy by a Registered Dietician in the Weight Management Outcome of Dyslipidemic Patients.

The aim of this research was to investigate the beneficial effect of medical nutrition therapy by a registered dietitian (R.D.) in the weight management of dyslipidemic patients. According to the National Cholesterol Education Program Adult Treatment Panel's second report on hyperlipidemia, dietary modification including weight management is an essential first step and that the registered dietitians (R.D.s) have the key responsibility to facilitate dietary behavior changes. Twenty-three dyslipidemic males (50–70yr.) in a lipid research trial requiring frequent dietary intervention with an R.D. were compared with 23 patients in another trial not requiring dietary intervention with an R.D. Weight gain of ≥3 lbs occurred in 43.4% of non-R.D. treated versus no weight increase in the R.D. treated group; p<0.01. Weight stabilization defined as gaining or losing ≤ 2 lbs occurred in twice as many subjects (61%) in the R.D. treated group versus the non-R.D. treated group (30%); p<0.05. Overall, compared with the non-R.D. treated group, the R.D. treated group experienced 57% additional benefit. The data establishes a significant beneficial relationship between medical nutrition therapy by an R.D. in the clinical management of dyslipidemia.