Nutrition%20Interventions%20to%20Improve%20Quality%20of%20Care

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Nutrition Interventions to Improve Quality of
Care

• Godfrey C. Xuereb
• Public Health Nutritionist

Caribbean Food Nutrition Institute
(CFNI) Specialised Centre of the Pan American
Health Organisation / World Health Organisation
II PAHO-DOTA Workshop on Quality of Diabetes
Care Diabetes Research Institute (DRI),
University of Miami 1416 May 2003
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Medical Nutrition Therapy (MNT)

• Nutrition is accepted as a cornerstone of
  diabetes management.
• MNT is a medically necessary and cost-effective
  way of managing diabetes.

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Medical Nutrition Therapy Principals

• Maintenance of near-normal blood glucose levels.
• Achievement of optimum lipid levels.
• Maintenance of attainment of reasonable weight.

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Medical Nutrition Therapy

• Quality Health Care today requires
• Consistently applied evidence-based care that
  leads to positive outcomes for most patients.
• DCCT described the benefits of an expanded role
  for dietitians and included close alliances with
  team members and active involvement in monitoring
  glucose levels and adjusting insulin doses.

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Medical Nutrition Therapy

• Nutrition Practice Guidelines have been developed
  and field tested
• Describe responsibilities.
• Guide practical decisions.
• Promote self-management training.
• Define state-of-the-art MNT based on available
  scientific evidence and experience of experts.
• Practice guidelines improve blood glucose when
  applied in the field.

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Source Franz M.J. et al. (1995) J Am Diet Assoc
96 (9) 1009-1017.
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Prioritising Nutrition Strategies

• Facilitating Behaviour Change
• Accurate nutrition information is essential.
• Information alone is not enough to change
  behavior.
• Several counselling and educational strategies
  are likely to improve the patients ability to
  apply nutrition recommendations.
• Readiness to change.
• Effective teaching and communication skills.
• Focusing on behaviour change.

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MONTSERRAT
SURINAME
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Professional to Population Ratio(Government
service only)
Source CFNI Study on Human Resources in the
Caribbean 2000.
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Sample
Additional 10 selected for these countries.
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Key Findings - 1
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Key Findings - 2
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Key Findings - 3
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Quality of Care

• Clinical Indicator
• Comprehensive practice guidelines and/or
  standards of care are followed and result in
  adequate control of blood glucose.

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Quality of Care

• Process Criteria
• Dietitian completes comprehensive history to
  assess health and nutritional status.
• Dietitian plans instructs patient in
  appropriate nutrition intervention, including
  moderate exercise, as tolerated, to promote
  control of blood glucose and lipid levels and
  appropriate weight loss.

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Quality of Care

• Process Criteria
• Dietitian documents patients comprehension,
  motivation and likelihood of adherence to
  treatment plan.
• Dietitian documents plans for monitoring and
  follow-up.
• Dietitian documents coordination of care with
  primary care provider and appropriate nursing
  staff as needed.
• Dietitian reinforces and monitors symptoms of
  hypoglycaemia and hyperglycemia.

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Quality of Care

• Outcome Criteria
• Patients blood glucose level decreases at least
  10 within 2 weeks of initial visit.
• Patients glycated HBA1c levels approach normal
  within 3 months of initial visit.
• Patients blood lipid levels approach normal
  within 2 months of attaining control of blood
  glucose levels.
• Patients dose of medication decreases over 6
  weeks on appropriate nutrition treatment plan.