Abstract
Background
Integrated health care models create opportunities for registered dietitian nutritionists
(RDNs) to provide nutrition-related care and engage in multidisciplinary teams to
improve clinical outcomes. While benefits of integrated care (IC) have been reported,
little is known about the impact of the RDN within an IC model.
Objective
Our primary objective was to identify whether IC vs traditional care (TC) increases
the number of RDN patient visits. Our secondary objective was to evaluate clinical
outcomes of patients seeing an RDN vs not, regardless of care model.
Design
This was a retrospective cohort study.
Participants/setting
Patients were aged 3 to 94 years and from a patient-centered medical home in Boston,
MA.
Main outcome measures
We measured 3-month total and average number of patients seen by the RDN in TC vs
IC. Changes in adult hemoglobin A1c, weight, and pediatric body mass index (measured
as kg/m2) among high-risk patients seen by an RDN compared to patients not seen by an RDN.
Statistical analysis
Data were obtained from electronic medical records and analyzed utilizing Mann-Whitney
U test, analysis of covariance, and paired sample t tests.
Results
The RDN saw 145 patients (137 adult, 8 pediatric) in the TC model compared to 185
patients (135 adult, 50 pediatric) in the IC model. Mean number of patients seen per
session was 3.20 in the TC model vs 4.63 in the IC model (P=0.004). Adult hemoglobin A1c within-group differences decreased by 0.42%±1.49% (P=0.007) for patients seen by an RDN and decreased 0.15%±1.47% (P=0.012) for patients not seen by an RDN. Adult weight within-group differences decreased
1.0±7.2 kg (P=0.15) for patients seen by a RDN and increased 0.1±5.6 kg (P=0.70) for patients not seen by a RDN. Pediatric BMI showed no change between or within
groups.
Conclusions
The IC model increased 3-month total number of patients seen by an RDN. High-risk
patients who saw an RDN had a significant decrease in hemoglobin A1c.
Keywords
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Biography
M. F. Warner is a pediatric dietitian, Upham’s Corner Health Center, Dorchester, MA, and a graduate student, Simmons College, Boston, MA.
Biography
K. E. Miklos is a graduate student, Simmons College, Boston, MA.
Biography
S. R. Strowman is an associate professor of practice, Department of Nutrition, School of Nursing and Health Sciences, Simmons College, Boston, MA.
Biography
R. M. Pojednic is an assistant professor, Department of Nutrition, School of Nursing and Health Sciences, Simmons College, Boston, MA.
Biography
K. Ireland is nutrition program manager, Codman Square Health Center, Dorchester, MA.
Article info
Publication history
Published online: July 17, 2018
Accepted:
May 1,
2018
Received:
July 9,
2017
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.
Identification
Copyright
© 2018 by the Academy of Nutrition and Dietetics.
