Improve Patient Health Outcomes Research Articles

Health literacy strategies: a Caribbean approach

Low health literacy is linked to poor health outcomes. Adequate health literacy depends on effective communication between patients and their healthcare providers, so it is important that physicians use health literacy strategies. This review article provides a brief account of the evolution of health literacy which shows a clear need to improve rates worldwide. It also addresses the relationship between the use of health literacy strategies and health outcomes; the physician’s role in health literacy including their implicit biases, training, gender, and region of training; and recommendations to improve policy-making, practice, and education in a Caribbean context. The implications for positive social change include the potential for health literacy training and inclusion in medical school curricula. The provision of health literacy training at all levels of education and practice aid in ensuring physicians are knowledgeable about the health literacy process, able to use strategies that can improve patients’ health literacy, and able to improve patient health outcomes. Recommendations on improving community literacy by engagement and empowerment are also discussed.

Health literacy strategies: a Caribbean approach

Low health literacy is linked to poor health outcomes. Adequate health literacy depends on effective communication between patients and their healthcare providers, so it is important that physicians use health literacy strategies. This review article provides a brief account of the evolution of health literacy which shows a clear need to improve rates worldwide. It also addresses the relationship between the use of health literacy strategies and health outcomes; the physician’s role in health literacy including their implicit biases, training, gender, and region of training; and recommendations to improve policy-making, practice, and education in a Caribbean context. The implications for positive social change include the potential for health literacy training and inclusion in medical school curricula. The provision of health literacy training at all levels of education and practice aid in ensuring physicians are knowledgeable about the health literacy process, able to use strategies that can improve patients’ health literacy, and able to improve patient health outcomes. Recommendations on improving community literacy by engagement and empowerment are also discussed.

Obstacle Analysis And Community Medicine Interprofessional Communication Solutions In Medical And Dental Students

Poor communication between doctors, patients and between health professionals, has a negative impact. The patient becomes disobedient to the doctor's intervention, the doctor becomes the target of violence due to the patient's ignorance. The World Health Organization (WHO) initiated Interprofessional Education (IPE) learning at the undergraduate level to improve communication and collaboration of health workers to improve patient health outcomes. This study aimed to analyze the barriers and solutions to community medicine interprofessional communication among medical and dental students. This study uses a qualitative method with a case study design. Observational data collection and focus group discussion (FGD). Students were divided into 16 groups, each consisting of 9 medical students and three dentistry students. Observation of IPE activities on collaborative practices in community residents in Sendangmulyo with five meetings for each group. FGD activities were carried out after collaborative approach with student representatives from each group. The results showed that the obstacles that occurred included: differences in competence and knowledge, lack of cooperation, lack of confidence, signal interference, differences in medical terms, miscommunication, and lack of response. Solutions: collaboration and complementarity, holding offline meetings, building closeness, gathering ideas, respecting each other's opinions, more accurate information, being open and trusting each other, being active listeners, giving others opportunities to express opinions, and using language that is easy to understand, repeating the explanation given

To Measure or Not to Measure: Perspectives of Measurement-Based Care From the Trenches

Measurement-based care has improved patient health outcomes by adding precision to clinical decision making at the patient level, when implemented correctly, across health care systems. Payors and system administrators also use measurements to assess program performance and inform resource allocation. This article describes frustrations and unintended consequences experienced by patients, psychiatric providers, administrators, and health systems when exuberant measurement, often without clearly stated goals, is promulgated with insufficient consideration as to the purpose, selection, and timing of these measurements by administrators and health systems. We propose some principles to inform when, how, by whom, and what to measure in managing the care of psychiatric patients. [ Psychiatr Ann . 2023;53(9):410–414.]

Penicillin allergy status and its effect on antibiotic prescribing, patient outcomes and antimicrobial resistance (ALABAMA): protocol for a multicentre, parallel-arm, open-label, randomised pragmatic trial

IntroductionIncorrect penicillin allergy records are recognised as an important barrier to the safe treatment of infection and affect an estimated 2.7 million people in England. Penicillin allergy records are associated...

Language-Concordant Care: a Qualitative Study Examining Implementation of Physician Non-English Language Proficiency Assessment

BackgroundLanguage concordance can increase access to care for patients with language barriers and improve patient health outcomes. However, systematically assessing and tracking physician non-English language skills remains uncommon in most health systems. This is a missed opportunity for health systems to maximize language-concordant care.ObjectiveTo determine barriers and facilitators to participation in non-English language proficiency assessment among primary care physicians.DesignQualitative, semi-structured interviews.ParticipantsEleven fully and partially bilingual primary care physicians from a large academic health system with a language certification program (using a clinician oral proficiency interview).ApproachInterviews aimed to identify barriers and facilitators to participation in non-English language assessment. Two researchers independently and iteratively coded transcripts using a thematic analysis approach with constant comparison to identify themes.Key ResultsMost participants were women (N= 9; 82%). Participants reported proficiency in Cantonese, Mandarin, Russian, and Spanish. All fully bilingual participants (n=5) had passed the language assessment; of the partially bilingual participants (n=6), four did not test, one passed with marginal proficiency, and one did not pass. Three themes emerged as barriers to assessment participation: (1) beliefs about the negative consequences (emotional and material) of not passing the test, (2) time constraints and competing demands, and (3) challenging test format and structure. Four themes emerged as facilitators to increase assessment adoption: (1) messaging consistent with professional ethos, (2) organizational culture that incentivizes certification, (3) personal empowerment about language proficiency, and (4) individuals championing certification.ConclusionsTo increase language assessment participation and thus ensure quality language-concordant care, health systems must address the identified barriers physicians experience and leverage potential facilitators. Findings can inform health system interventions to standardize the requirements and process, increase transparency, provide resources for preparation and remediation, utilize messaging focused on patient care quality and safety, and incentivize participation.

“I feel drug resistance testing allowed us to make an informed decision”: qualitative insights on the role of HIV drug resistance mutation testing among children and pregnant women living with HIV in western Kenya

BackgroundPregnant women and children living with HIV in Kenya achieve viral suppression (VS) at lower rates than other adults. While many factors contribute to these low rates, the acquisition and development of HIV drug resistance mutations (DRMs) are a contributing factor. Recognizing the significance of DRMs in treatment decisions, resource-limited settings are scaling up national DRM testing programs. From provider and patient perspectives, however, optimal ways to operationalize and scale-up DRM testing in such settings remain unclear.Methods Our mixed methods study evaluates the attitudes towards, facilitators to, and barriers to DRM testing approaches among children and pregnant women on antiretroviral therapy (ART) in five HIV treatment facilities in Kenya. We conducted 68 key informant interviews (KIIs) from December 2019 to December 2020 with adolescents, caregivers, pregnant women newly initiating ART or with a high viral load, and providers, laboratory/facility leadership, and policy makers. Our KII guides covered the following domains: (1) DRM testing experiences in routine care and through our intervention and (2) barriers and facilitators to routine and point-of-care DRM testing scale-up. We used inductive coding and thematic analysis to identify dominant themes with convergent and divergent subthemes.ResultsThe following themes emerged from our analysis: (1) DRM testing and counseling were valuable to clinical decision-making and reassuring to patients, with timely results allowing providers to change patient ART regimens faster; (2) providers and policymakers desired an amended and potentially decentralized DRM testing process that incorporates quicker sample-to-results turn-around-time, less burdensome procedures, and greater patient and provider “empowerment” to increase comfort with testing protocols; (3) facility-level delays, deriving from overworked facilities and sample tracking difficulties, were highlighted as areas for improvement.ConclusionsDRM testing has the potential to considerably improve patient health outcomes. Key informants recognized several obstacles to implementation and desired a more simplified, time-efficient, and potentially decentralized DRM testing process that builds provider comfort and confidence with DRM testing protocols. Further investigating the implementation, endurance, and effectiveness of DRM testing training is critical to addressing the barriers and areas of improvement highlighted in our study.Trial RegistrationNCT03820323.

Results of the nursing care standardization program in cardiac electrophysiology patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients undergoing surgery in the electrophysiology unit pass through the hands of several nurses from different hospital units throughout the care process. Multiple studies show the importance of interprofessional communication in improving patient health outcomes. In our hospital we have standardized protocols for each procedure. In addition, it is convenient to have the relevant information available in a more visual and accessible way in order to enhance the agility of care. Purpose To design a summary table of the procedures performed in the electrophysiology unit with the most important points on nursing care. Methods A descriptive analysis of the nursing care of patients undergoing surgery in the cardiac electrophysiology unit was performed. For this purpose, meetings were held between the electrophysiology, the intensive care unit, the cardiology day hospital and the resuscitation unit nursing teams to standardize protocols between services. The needs of each service were detected and the most important nursing care notes were included in the table. Results A table was drawn up with a total of 8 surgical procedures performed in electrophysiology. For each of them, 3 parts of the care process were identified: pre-operative, intraoperative and post-procedure care. Each of the parts had subdivisions (Picture 1 and 2). In addition, important contact telephone numbers were added. Once the table was done and validated, it was shared through the hospital intranet and hung in a poster in all hospital units where a cardiac patient may be attended. Conclusions The electrophysiology patient care table improved communication between professionals of the different services where the patient is attended and it also helped standardize protocols to reduce peri-surgery risks and improve morbidity and mortality, since it could prevent complications. Therefore, it guarantees the continuity of nursing care.Poster TS EF Procedure

Factors affecting emergency department use among pediatric immigrants and refugees: A qualitative narrative review

Purpose: To identify factors affecting emergency department (ED) use by immigrant and refugee children under the age of 18 years in North America and Europe, where similar primary, secondary, and tertiary healthcare structures exist. Methods: A narrative review methodology was used to complete a search of three databases including CINAHL, MEDLINE, and SCOPUS. Inclusion criteria and exclusion criteria were applied following screening and full-text review, resulting in the 8 articles that were selected for this review. Results: Six central themes were identified for presentation to ED’s including: (1) financial accessibility; (2) health insurance; (3) presence of a primary care provider; (4) language barriers; (5) transportation; and (6) health literacy, with health literacy further being divided into a lack of knowledge and parental perception and understanding of illness. Implications and Conclusion: Factors that influence ED use by pediatric immigrant and refugee patients are multi-factorial and interconnected. Recommendations are made to encourage informed changes based on population healthcare needs, with the overall goal to reduce non-essential ED use and improve patient health outcomes. While this review identifies and evaluates the limited research available in this area, further studies need to be completed before generalizations can be made for all pediatric immigrant and refugee populations.

Barriers to Accessing Oncology Services for Effective Cancer Care in the Public Health Institutions in Limpopo Province, South Africa: A Qualitative Study.

It is estimated that by 2030, 24 million people worldwide will develop cancer, and 13 million will die annually, with 75% of deaths in low- and middle-income countries. The management and effective control of care have not been fully achieved due to a lack of material and human resources exacerbated by poor governance and co-ordination of the services. The study aimed to explore barriers to accessing oncology services for effective cancer care in the public health institutions in Limpopo province. The study was conducted in the five district hospitals in Limpopo province. A qualitative exploratory descriptive and contextual approach was used to collect data that employed focus group discussions amongst healthcare professionals in different disciplines. Non-probability purposive sampling was used to sample participants from various sections contributing to oncology care. Five focus group discussions were conducted at the selected hospitals. The data were analysed using the eight steps of Tesch's method. The findings revealed that Limpopo province has a shortage of high-technology medical equipment, poor coordination, and a lack of oncological and allied expertise. Governments should ensure that patients receive the care required as stated in the constitution to navigate cancer care pathways to improve patient health outcomes, particularly in rural areas where care is fragmented and poorly financed. Recommendations to support oncology patients involve psychosocial work and palliative care of the multidisciplinary teams to be put forward. The identified barriers regarding oncology care may contribute to changing the departments' outlook and effective functioning by including interdisciplinary oncology teams at all levels of care.

Experiences of patients with chronic diseases during the COVID-19 pandemic in the North West province, South Africa.

Patients with chronic diseases (PWCDs) were severely affected by the coronavirus disease 2019 (COVID-19) pandemic, as they were prevented from making the necessary visits to health facilities for medical review and to collect their medication. The emergence of the health crisis and inadequate access to quality care affected chronic care management. The perspectives of PWCDs are not known, and therefore the research on which this paper is based sought to investigate the lived experiences of these patients during the COVID-19 pandemic. A qualitative phenomenological design was used to obtain the lived experiences of PWCDs identified for participation in the study by means of purposive sampling. Patients' experiences were obtained during individual structured interviews, and a checklist was used to gather patient characteristics from their files. Three themes emerged from the study findings, namely poor healthcare services, the socio-economic impact of the COVID-19 pandemic, and the psychological impact of the COVID-19 pandemic. The COVID-19 pandemic had devastating effects on PWCDs, in that they experienced barriers to accessing quality chronic care services and suffered psychological and financial difficulties that affected their health, life, needs and expectations. Policymakers should consider PWCDs when responding to a public health concern in the future.Contribution:The study findings may have an impact on future policies regulating the management of chronic diseases during epidemics, in order to improve patient health outcomes and satisfaction with healthcare services and the chronic care model based on the experiences of PWCDs.

Supported self-management for all with musculoskeletal pain: an inclusive approach to intervention development: the EASIER study

BackgroundSupported self-management interventions for patients with musculoskeletal (MSK) conditions may not adequately support those with limited health literacy, leading to inequalities in care and variable outcomes. The aim of this study was to develop a model for inclusive supported self-management intervention(s) for MSK pain that take account of health literacy.MethodsA mixed methods study with four work-packages was conducted: work package 1: secondary analysis of existing data to identify potential targets for intervention; work package 2: evidence synthesis to assess effective components of self-management interventions taking into account health literacy; work package 3: views of community members and healthcare professionals (HCPs) on essential components; work package 4: triangulation of findings and an online modified Delphi approach to reach consensus on key components of a logic model.FindingsFindings identified targets for intervention as self-efficacy, illness perceptions, and pain catastrophizing. A range of intervention components were identified (e.g. information in diverse formats offered at specific times, action planning and visual demonstrations of exercise). Support should be multi-professional using a combination of delivery modes (e.g. remote, face-to-face).ConclusionsThis research has developed a patient-centred model for a multi-disciplinary, multi-modal approach to supported self-management for patients with MSK pain and varying levels of health literacy. The model is evidence-based and acceptable to both patients and HCPs, with potential for significant impact on the management of MSK pain and for improving patient health outcomes. Further work is needed to establish its efficacy.

Educational tools to dismantle disparities by addressing social determinants of health

Background: Social determinants of health (SDOH) are personal, social, economic, and environmental factors that contribute to health disparities in the United States. Objectives: To develop educational interventions to teach and assess students’ knowledge about health disparities using a SDOH framework, and design assessment methods to identify theory-based interventions to improve patient health outcomes. Methods: Educational tools utilising a SDOH framework were designed for students to learn about health disparities. A socio-ecological model allowed students to assess multi-level determinants of health and propose more effective interventions. Evidence-based questions were designed to address the health of a specified population. A case study allowed students to apply therapeutic knowledge and clinical interventions to improve patient health. Results: Exactly 44 students enrolled in three iterations of the course and completed pre- and post-surveys. Upon completion, students’ perception of health disparities significantly increased. Conclusion: The SDOH model offers strategies for other pharmacy programs seeking to increase public health-related topics. Students can develop skills to directly apply to a current problem and then build theory to engage in problem-solving. This innovative approach utilising SDOH for pharmacy students positively impacted awareness and knowledge.

EE326 Malnutrition Prevalence and Economic Burden Among US Hospitalized Older Adult Patients with and without COVID-19

Malnutrition is a prevalent condition affecting 30-50% of hospitalized patients. Malnutrition is linked to impairments in health outcomes and increased economic burden on healthcare systems. We assessed the prevalence and burden of malnutrition by examining demographic characteristics, Disease Related Group (DRG) payments and associated claims among Medicare inpatients (65+ years) with and without COVID-19. Hospital inpatient COVID-19 claims from the Centers for Medicare & Medicaid Services (CMS) Inpatient Prospective Payment System (IPPS) between October 2020 - September 2021 were analyzed. The International Classification of Diseases, Tenth Revision, and Clinical Modification (ICD-10-CM) were used for malnutrition diagnoses. Demographic variables were compared based on the COVID-19 status; economic burden was analyzed by DRG payment of malnutrition cases with and without COVID-19. Among 7,394,657 Medicare inpatient claims, only 12% had a documented malnutrition diagnosis. Of these patients, 1.2% had COVID-19. Regardless of COVID-19 status, malnourished patients averaged 75 years of age, and were predominantly female (54%) and White (78%) followed by Black (14%), and Hispanic (2%). Sepsis, kidney failure, and urinary tract infection (UTI) were the most common primary diagnoses in malnourished patients, regardless of COVID-19 status. Malnourished patients with COVID-19 had significantly higher DRG payments ($27,407 vs. $18,327) and increased cost of outlier payment ($3,208 vs. $2,049) compared to those without COVID-19, regardless of other diagnoses. Malnutrition diagnosis was confirmed in only 12% of the Medicare inpatients, thus suggesting that malnutrition continues to be underdiagnosed and undertreated --- evidenced by high rates of hospitalizations/claims and payments in both COVID-19 and non-COVID-19 cases. It is imperative for hospitals to implement nutrition-focused protocols to identify, diagnose and address malnutrition among all Medicare inpatients regardless of COVID-19 status (and especially among patients with sepsis, kidney failure, and UTI). Nutrition-focused protocols can effectively improve patient health outcomes and reduce healthcare costs.

Are performance-based payment structures more strongly correlated with better health outcomes compared to solely fee-for-service payment for surgeons?

For years, the healthcare industry has compensated its surgeons with a simple fee-for-service model. With more payment structures becoming prevalent, we decided to review one specific type of payment structure, pay-for-performance, and its impact on patient health outcomes. We hypothesized that, on average, across all specialties, performance-based contracts would yield better health outcomes compared to fee-for-service payments alone. We also hypothesized that performance-based contracts might pressure physicians to get results and could lead to mistakes and a worse quality of care. We reviewed nine papers from 2006-2014, of which the majority were conducted in the United States, with one each from Italy and Germany. Our review included three literary/systematic reviews, three before & after studies, and two cross-sectional analyses. Many papers did not provide strong evidence of the effect of pay-for-performance on health outcomes, although examined papers agree on certain things. A common theme we found was the pay-for-performance increased documentation and the number of procedures done, but with minimal conclusions about outcomes. This may result from poor or non-standardized metrics being used to measure and report “performance.” However, two studies found that pay-for-performance improved patient health outcomes, despite limitations. For example, Brosig-Koch et al., (2013) found that P4P was not cost-effective from a solely financial standpoint.

Plain Language Summary of principles for improving the care of people with eosinophil-associated diseases.

Eosinophil-associated diseases (EADs) are a group of conditions in which eosinophils (a type of white blood cell) are thought to play a key role in the disease and how it develops. Some EADs are common, such as atopic dermatitis (also called eczema) and a subtype of asthma called eosinophilic asthma, while others are rare, such as hypereosinophilic syndrome (a condition in which a person has a very high number of eosinophils in both the blood and one or more organs). People with EADs face many problems related to their conditions. Symptoms such as severe abdominal pain, itch, or shortness of breath impact both the patient as well as their friends and family. Patients with EADs also experience delays to diagnosis and treatment as well as financial barriers. Healthcare professionals sometimes fail to recognize the complex set of symptoms that characterize an EAD, and this may cause delays in reaching a correct diagnosis. As a result, it may take longer for a patient to get the best care and the most effective treatments, which may contribute to poor health. The goal of this charter is to describe the key elements of good quality care, which all people with EADs deserve, as well as to present an action plan to improve health and overall well-being for people with EADs. Proposed use of this patient charter: The principles described in this charter (a written guide to achieve an outcome) show the core elements of quality care that people with EADs must receive. They also describe clear steps to reduce the burden on patients and their caregivers and to improve patient health outcomes. We urge healthcare professionals, hospitals, and policymakers around the world to adopt these principles quickly. By doing this, people with EADs will be more likely to receive an accurate and timely diagnosis and have access to quality care and treatment in the right setting.

The Impact of Secure Messaging in the Treatment of Patients With Diabetes Within a Primary Care Setting: Protocol for a Scoping Review

Diabetes-a high-burden chronic disease-requires lifetime active management involving the use of different tools and health care resources to improve patient health outcomes. Recent studies have demonstrated promising results regarding the impact of the use of virtual care technology on the treatment of chronic diseases, such as diabetes. However, it is unclear whether the use of technologies, such as secure messaging, improves the quality of care and reduces diabetes-related costs to the health care system. The purpose of our scoping review is to explore what is known about the use of secure messaging in the treatment of diabetes within the primary care setting and how its impact has been assessed from the patient and health system perspectives. Our review aims to understand to what extent secure messaging improves the quality of diabetes care. Our scoping review will follow the 6-step Arksey and O'Malley methodological framework, as well as the Joanna Briggs Institute methodology for scoping reviews and their recommended tools. The tools to guide the development and reporting of the review in a structured way will include the Population, Concept, and Context framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines and checklist. The search strategy was developed iteratively in collaboration with a professional information specialist. Furthermore, a peer review of electronic search strategies was also conducted by an independent, third-party, professional information specialist. A systematic literature search will be conducted against databases, including Ovid MEDLINE ALL, Embase, APA PsycINFO, Cochrane Library on Wiley, CINAHL on EBSCO, and PubMed. Grey literature sources will also be searched for relevant literature. Literature on the use of secure messaging in the treatment of diabetes (types 1 and 2) within a primary care setting will be included. Two reviewers will review the literature based on the inclusion criteria in the following two steps: (1) title and abstract review and (2) full-text review. Discrepancies will be discussed to reach consensus where possible; otherwise, a third reviewer will resolve the dispute. The results and a final report are expected to be completed and submitted to a peer-reviewed journal in 6 months. The review will examine existing literature to identify the impact of secure messaging in diabetes treatment within primary care settings. Research gaps will also be identified to determine if there is a need for further studies. DERR1-10.2196/42339.

Hospital cost efficiency: an examination of US acute care inpatient hospitals.

The use of stochastic frontier models for inference on hospital efficiency is complicated by the inability to fully control for quality differences across hospitals. Additionally, the potential existence of cross-sectional dependence due to the presence of unobserved common factors leads to endogeneity problems that can bias both cost function and efficiency estimates. Using a panel consisting of 1518 hospitals for the years 1996-2013 (T=18), I adopt techniques for dealing with long, cross-sectionally dependent panel data in order to estimate cost parameters and hospital specific efficiency. In particular, I employ the estimation technique proposed by Bai (Econometrica 77(4):1229-1279, 2009), which assumes that the unobservable heterogenous effects have a factor structure. I find evidence of considerable scale economies and that hospital cost inefficiencies have been increasing during the period of 1996-2013, and that the growth in expenditures is, in part, driven by spending that increases patient satisfaction, but that does not significantly contribute to improved patient health outcomes.

Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study.

Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care. Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients' characteristics over time, and significant changes in the rates were identified by joinpoint regression. The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic. The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.

Individualized diet conversation in primary care: A pilot intervention.

Most primary care providers do not routinely discuss nutrition and diet with their patients, largely due to lack of time, inadequate resources, and perceived complexity of the topic. This article describes development and implementation of a brief protocol for systematically assessing and discussing diet during routine primary care visits to increase the frequency of these conversations and improve patient health outcomes. The authors developed a protocol for assessing both nutrition and stage of change as well as a guide for engaging in patient-led conversations about nutrition. The protocol was modeled after Screening, Brief Intervention, and Referral to Treatment and informed by the Dietary Guidelines for Americans, the Transtheoretical Model of Behavior Change, and principles of motivational interviewing. It was implemented over three months at a rural health clinic staffed by one NP. The protocol and conversation guide were easy to use with minimal training and seamlessly incorporated into clinic workflow. The likelihood of making diet changes increased significantly following the diet conversation, with persons who initially scored lower in readiness to change ultimately reporting significantly greater increases. A protocol for assessing diet and engaging patients in a stage of change-appropriate diet conversation can be efficiently integrated into a single primary care visit and increase patients' intent to change their diet. Further investigation is needed to evaluate the protocol more completely and in multiple clinics.