Outpatient Nutrition Clinic Research Articles

Comparing attendance rate, referral turn around time, and patient satisfaction in an outpatient nutrition clinic model using several satellite clinic sites versus a model using one clinic site

Comparing attendance rate, referral turn around time, and patient satisfaction in an outpatient nutrition clinic model using several satellite clinic sites versus a model using one clinic site

Outcome of patients consulting in an outpatient nutrition clinic for excessive body weight

Few data are available concerning long-term outcome of patients after individually consulting a nutrition specialist, without entering a structured program. The objective of the present study was to evaluate outcome and predictors of body weight loss (BWL) after consulting in an outpatient nutrition clinic. Phone interview of 95 patients (age 46.1 +/- 1.4 years, BMI 33.8 +/- 0.7 kg/m(2)) out of 299 who consulted consecutively for the first time in an outpatient nutrition clinic for excessive body weight. The mean time interval between first visit and phone interview was 2.1 +/- 1.3 years. Average BWL was 6.7 +/- 1.2 kg for the entire group. Forty-eight patients (50.5%) had lost more than 5% of initial body weight and were considered to be successful. Initial BMI was associated with% BWL (r=0.42, p<0.0001). Underreporting of energy-intake at initial dietary history was positively associated with BWL (- 11.8 +/- 1.1 vs. - 5.1 +/- 3.9 kg, p<0.05) as well as the number of visits attended by the patient (p=0.04). No relation was found between sex, age and physical activity at initial visit, past history of dieting or time elapsed since first or last visit and BWL. In multivariate analysis under reporters had 4.3 times more chances to lose more than 5% of their body weight (p<0.05). Visiting a nutrition specialist to receive individual counseling and prescription of a balanced low calorie diet is part of a positive behavior change leading to body weight loss.

The incidence of binge eating disorder in ametropolitan outpatient nutrition clinic

The incidence of binge eating disorder in ametropolitan outpatient nutrition clinic

Integration of Nutrition Education into a Multidisciplinary Cardiac Rehabilitation Program

The multidisciplinary Cardiac Rehabilitation Program (CRP) at Wilford Hall Medical Center was redesigned to improve both efficiency and effectiveness of services offered to patients following recovery from either myocardial infarction or cardiac bypass surgery. Services were redesigned to provide a “one stop shop” approach for minimizing inconvenience to patients and for achieving the CRP's goals of increasing functional cardiac capacity, improving quality of life, and reducing risk of future cardiac events. To preclude problems encountered in the old program such as record unavailability, multiple patient visits to referral clinics, and lack of communication between referral clinics and the Primary Care Provider, several innovations were introduced. The CRP was reorganized into two phases of rehabilitation. During Phase 1, psychological and physical education sessions were provided in a group format followed by a second phase of rehabilitation highlighted by close individual follow-up. Nutrition Education was incorporated during Phase 1 through a six-week behavior modification program that included stress reduction and goal setting. A total of 75 patients have graduated from Phase 1 of the program. Eighty Percent have achieved weight loss of 5–10 pounds in 6 weeks and/or 15–25 pounds in 6 months. Eighty-five percent of nutrition goals set have been achieved. Ninety percent of patients have a perceived improvement in the quality of their lives and 95% have increased energy to complete activities of daily living. During Phase 2 of the program, the dietitian involved in the cardiac rehabilitation provides individual follow-up or consultation to the appropriate nutrition class. To date, 26 Phase 2 patients have been referred to the nutrition clinic for education. Thirteen of these received instruction from the cholesterol reduction program taught by the outpatient nutrition clinic. Seventy-seven percent of these patients have seen a decrease in their cholesterol levels. Multidisciplinary clinics have the unique ability to successfully provide effective and efficient patient care.

Enhancing Nutritional Care for Head and Neck Surgery Patients Through the Development of a Critical Pathway

LEARNING OUTCOME: To establish guidelines for nutrition intervention of head and neck surgery patients in a critical path. Head and neck cancer patients who undergo surgical resection of the oropharyngeal area and tissue reconstruction often experience dysphagia and require tube feeding (TF) during the early post-operative period. Pre-existing malnutrition in this population is prevalent. Prompt assessment and interdisciplinary communication to facilitate optimal nutrient delivery in a timely manner may improve patient outcome. A multidisciplinary team developed a critical pathway (CP) for “Free Flap” surgery. It delineates specific interventions to be provided at pre-determined time points during the anticipated length of stay (LOS). Emphasis is placed on early identification of patients who require TF. Nutrition consultation, height, weight, albumin, pre-albumin are ordered on the day of admission. TF is started on post-operative day (POD) 2 using an isotonic, polymeric formula, continuous infusion, and gradually advanced over the next 24 hours to goal rate. By POD 4, oral feeds may start as determined by an instrumental assessment of swallow function (modified barium swallow). TF is transitioned as tolerated to an intermittent/bolus schedule and discharge planning begins. The nutritionist communicates formula selection, equipment needed and administration schedule to the primary nurse and Quality Support Service coordinator to arrange home care services. Malnourished patients or those in transition to oral feeds will be referred to the out-patient nutrition clinic for follow-up. In the era of managed care, shortened LOS compels timely intervention and interdisciplinary coordination to maintain/ improve patient care. Incorporation of these practice guidelines ensures that nutrition intervention is provided efficiently through the continuum of care. Data on variance need to be gathered and analyzed to be used in outcomes measurement.

Value-added services that increase physicians' intent to refer patients to an outpatient nutrition clinic

We surveyed 378 practicing physicians to identify value-added services that would increase their patient referrals to registered dietitians at an outpatient nutrition clinic. One hundred thirty-nine completed surveys were used in compiling the results. In the survey we presented 16 value-added services specifically designed to overcome physicians' barriers to referral as noted in the literature, and we requested demographic information. Frequency distributions revealed that the services physicians most strongly agreed would increase their referrals were help patients receive reimbursement from third-party payers (92.1%), provide a free initial meeting with the patient (82.4%), and offer group cooking classes (81.3%). The services physicians most strongly disagreed would increase their referrals were provide a list of physicians currently using the outpatient nutrition clinic who can provide recommendations (33.1%) and provide a free consultation for the physician (30.2%). Our findings indicate that (a) value-added services most likely to stimulate referrals are those that moderate the cost of nutrition counseling, document its effectiveness, and provide skills training in the form of cooking classes, and (b) value-added services least likely to stimulate referrals are those that require physicians' time.

Continuing education questionnaire for RDs and DTRs

<h2>Abstract</h2> We surveyed 378 practicing physicians to identify value-added services that would increase their patient referrals to registered dietitians at an outpatient nutrition clinic. One hundred thirty-nine completed surveys were used in compiling the results. In the survey we presented 16 value-added services specifically designed to overcome physicians' barriers to referral as noted in the literature, and we requested demographic information. Frequency distributions revealed that the services physicians most strongly agreed would increase their referrals were help patients receive reimbursement from third-party payers (92.1%), provide a free initial meeting with the patient (82.4%), and offer group cooking classes (81.3%). The services physicians most strongly disagreed would increase their referrals were provide a list of physicians currently using the outpatient nutrition clinic who can provide recommendations (33.1%) and provide a free consultation for the physician (30.2%). Our findings indicate that (a) value-added services most likely to stimulate referrals are those that moderate the cost of nutrition counseling, document its effectiveness, and provide skills training in the form of cooking classes, and (b) value-added services least likely to stimulate referrals are those that require physicians' time.

Transition from quality assurance to quality improvement: A dietetic department model

As JCAHO transitions to quality improvement, the challenge of dietetic departments is to continuously evolve their programs. A comprehensive departmental program is presented which includes quality assessment and quality control indicators that met with the approval of 1993 JCAHO surveyors. Quality assessment results are tracked on numerous indicators, such as: patron, inpatient and outpatient nutrition clinic customer satisfaction; patient tray accuracy and temperature; and nutrition clinic appointment waiting time. One indicator, patient tray accuracy and temperature, developed into a Total Quality Management process improvement team project. Team composition includes eight personnel from all levels in the department, such as dietitians, trayline supervisors, and food service workers. Team recommendations to improve tray accuracy resulted in reorganization of food items on the patient selective menu, reallignment of food service equipment, and reorganization of trayline positions and duties. Quality control indicators are: training, kardex and menu accuracy, financial data, quarterly inventory level, supply budget versus actual, safety incidents, meals served, recipe pricing, and utilization of the dining room by customer group. A year by year transition is shown, 1991 to 1994. Current data is presented and displayed using graphics, such as trend charts and bar graphs, to analyze trends and identify further areas for improvement. The overall department program continually changes based on results and future needs and opportunities for improvement.

Delegation of clinical dietetic tasks in military and civilian hospitals: Implications for practice

The purposes of our research were two-fold: to determine perceptions of the quality of task performance and to identify dietetic personnel currently performing clinical dietetic tasks in military and civilian hospitals. Questionnaires were returned from 309 dietitians and 208 dietetic support personnel at 151 military and civilian hospitals (73% response overall). For tasks completed by support personnel, no task was rated as having optimum quality, 1 was rated as highly acceptable, 6 as acceptable, 19 as somewhat unacceptable, and 4 as unacceptable. Current performance ratings indicated that 1 task was performed solely by dietitians, 21 were completed by dietitians with assistance, 6 were completed jointly by dietitians and support personnel, 2 were completed by support personnel with supervision by dietitians, and no task was completed independently by support personnel. Tasks were grouped into four categories: basic clinical dietetics (11 tasks), intermediate and in-depth clinical dietetics (12 tasks), outpatient nutrition clinic (5 tasks), and nutrition education (community) (4 tasks). Quality scores for the US Air Force (USAF) hospitals were higher for all task categories except intermediate and in-depth clinical dietetic tasks. The quality scores of support personnel were higher than those of dietitians for all task categories. The USAF performance scores indicated significantly more involvement of support personnel. Generally, the performance scores of dietitians increased with experience; the scores of support personnel decreased with experience. Correlations between quality and performance ratings for individual tasks revealed low to moderate relationships. Our results suggest that additional delegation of tasks to dietetic support personnel may be possible without negatively affecting perceptions of the quality of task outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Weight loss maintenance 1 year after individual counseling

Many individual and group weight loss programs can boast short-term success. There has been little documentation on the long-term success of any particular program. A study was conducted to examine total weight loss for individually counseled patients seen in a hospital outpatient nutrition clinic February to October 1986. All patients who lost weight were contacted via telephone 1 year later to ascertain weight loss maintenance. During this period, 157 patients were seen. In an average of five visits, 119 (75%) lost an average of 9 lb. One year later, 73 (61%) of these patients were contacted, 54 of whom (74%) reported that they had either maintained or lost additional weight during the year. Sixteen (30%) of these 54 individuals lost additional weight during the year--an average of 13 additional lb. Results were similar for men and women. Although based on a small sample size, the results suggest that weight loss counseling can be successful in maintaining as well as losing weight. Such results should encourage dietetic practitioners to track their own patients for long-term results and to share the results with physicians, administrators, and insurers who are concerned about whether their money has been well spent.

Predicting weight loss success among obese clients in a hospital nutrition clinic

A retrospective study of 63 obese patients seen in a hospital outpatient nutrition clinic was reported. The majority suffered from one or more other medical problems. The relationship of amount of and rate of weight loss to various factors was examined. The multivariate analysis revealed that either the amount or rate of weight loss was greater in the patients who were more overweight initially, white, male, young, single, older at age of onset of obesity, visited the clinic for a longer period of time but less frequently. Conversely, the amount or rate of weight loss was less in those patients receiving conjugated estrogens, oral contraceptives, propranolol, thioridazine HCl, and those who were receiving behavior modification as treatment.