Research Activity

Dietetics Practice-Based Research Network (DPBRN).  Over 400 members have completed all or part of the enrollment process to be part of the DBPRN.  Funding has been received from various sources to support this year’s activities (ADAF, CDR, and ADA).  The first meeting of DBPRN members was in April 8-10, 2005 for 40 members who are participating in the CTIMEE study.  The sessions during the meeting include basics of Institutional Review Board processes, data collection, confidentiality, and study specific training (e.g. how to use med-gem and complete study instruments).Dr Linda Snetselaar was approved by the Research Committee as the DPBRN Director in May 2005.  The DBPRN Oversight Group met in September 2005 to discuss this year’s activities.  Three projects were selected for development:  Descriptive study of network capability, Field test of IC Appendix (Critical Thinking In Measuring Energy Expenditure-CTIMEE), and Standardized Language:  Nutrition Diagnosis.  Policies and procedures have been developed by the DPBRN Oversight Group chaired by Patti Landers.  ADAF and CDR funded the initial descriptive study, and interim and the first year of the permanent director.

Evidence-Based Practice.  To meet the growing demand for ADA Evidence Analysis (EA) projects, six evidence analysis workshops have been offered in Chicago since 2002.  At the present time, 57 ADA members are actively involved in evidence analysis.  An Evidence Analysis Library (EAL) was activated in September 2004 and the new Evidence-Based Guidelines section was activated in June 2005.  Results of evidence analysis are being posted daily from the 17 ongoing projects.  The Research Committee approved a modification of the EA Grading system to include a grade V that indicates that insufficient research is available to answer the question.  The next EA workshop will be held November 14-15, 2005.  These are funded by ADA, CDR, DPGs, and external funders.

Current Ongoing or Proposed Research Studies

Nutrition Quality of Life (NQoL) (Phase I):  
The NQoL Study was conducted by Dr. Judith Barr and Dr. Gerald Schumacher from Northeastern University with funding from the ADAF (Novation and Abbott Laboratories).  Focus groups with clients and dietitians have formed the basis for establishing a draft instrument that will measure the unique contribution of RDs to client's ability to "cope" with their nutritional considerations.  The draft NQoL instrument was presented at FNCE 2001 and Nutrition week in February 2002. The article summarizing the development was published in February 2003 JADA.  A proposal for a full validation study was submitted to NIH; however, received a score too low for funding.  ADAF funded this through an unrestricted grant from Novation.

International Diabetes Outcomes Study (IDOS):  
The IDOS study will evaluate outcomes from implementing the ADA MNT Guides for Practice for Adult Type I and II Diabetes in Israel, Turkey, and Arabic country.  A coordinator and five dietitians in each country were trained (in December 2003 & September 2004).  The guides have been translated to Hebrew, Turkish and Arabic.  Lebanon was selected as Arabic country and dietitians were trained in Turkey in January 2005.  Abbott approved funding for glucometers and strips for the subjects for a one year period in all three countries.  The data collection forms were modified based on the initial pilot testing. ADAF is funding this research project through the Wimpfheimer-Guggenheim Fund for International Exchange in Nutrition, Dietetics and Management.

Healthy Eating and Activity Study/Pediatric Research in Office Setting: 
ADA is collaborating with CDC on a pilot study to evaluate whether motivational interviewing provided by RDs in the pediatric office setting is effective in preventing the development of obesity in children.   ADA supported the Motivational Interviewing  (MI) training in January 2002 for the RD and Pediatricians involved in the study with partial funding from ADAF's Physician Nutrition Education program (Gerber).  Subjects are being recruited in early 2004.  This study will include five practices in each of three arms: Control (usual care pediatrician), Minimal (pediatrician 5 min MI) and Intensive (pediatrician and RD MI).  Subjects are being enrolled and participating in the study now.  ADAF supported the Motivational Interviewing training for this research project. A follow-up to this study, BMI2, that will involve five regions throughout the United States has been submitted to NIH for funding.   

Family Nutrition and Physical Screening Tool:
The initial proposal for development and validation of a short screening tool that will use family characteristics most closely linked to development of childhood obesity.  The proposal development has been supported by The Ann Hertzler Fund and Healthy Weight for Kids.  A proposal planning meeting was held on June 13, 2002.  The proposal outlining the conceptual areas to be included, researchers to be involved, and validation methodology for Phase I was initially submitted in August 2002 and recently resubmitted in April 2004 to MCHB for review.  The PIs are Patricia Crawford and Lorrene Ritchie (UC Berkeley Center for Weight and Health), Karen Peterson (Harvard), Greg Welk (Iowa State University) and Esther Myers (ADA).  A smaller pilot study was submitted to NIH in October 2004 under the R-03 announcement of NIDDK and is being resubmitted in November 2005. ADAF funded the initial work on this project.

Civic/Community Nutrition Environmental Support Assessment Tool:
A workshop with evaluation component addressing barriers and successes is included in the Partners in Program Planning for Adolescent Health application which is funded by HRSA/MCHB for 2002-2006.  The first two phases of the evaluation have been completed for participants of the September 2004.  The second and third workshops wereas held in March 2005 and September 2005.  The evaluation will continue throughout 2006.

Validation of Nutrition Risk Assessment:
Expert long-term care dietitians have developed a tool for use by RDs that is intended to identify long-term care clients that are at highest risk and those who would benefit from RD services.  This tool needs to be validated. The CDHCF DPG has funded the proposal preparation ($5,000) and the proposal was submitted to AHRQ for funding.  Other sources of funding are being explored in addition to revising the proposal.  In Spring 2004, a Pilot data collection was incorporated in revisions of the proposal.  Materials were posted on CDCHF with facility enrollment beginning during May 2004.  Fifteen dietitians are enrolled and are collecting data.

Annual Outcomes Grant:
The Research Committee recommended that an ultimate goal for ADA would be to establish an ongoing $50,000 annual outcomes grant.  A central research proposal writing meeting would develop a RFA for RDs to apply to conduct the research.  Topics will be chosen each year depending on current needs by the Research Committee and support will be requested from ADAF Research Endowment Fund.

Standardized Language:
ADA has completed the initial phases of the standardized language (terminology and definitions) for nutritional diagnosis, to be included in future outcomes research that documents clinical care outcomes, and included in automated medical record data entry/retrieval.  Currently being completed is Pam Charney’s initial research on whether dietitians with varying experience levels select the same terms for cases.  The next phase of the research on nutritional diagnoses in practice was one of the topics selected by the DBPRN task force for development this year.  Dr. Evelyn Enroine will be working with ADA during her sabbatical to develop the research protocol and conduct the first of the descriptive studies documenting how the terms are used in practice.  Approximately 30 dietitians in the DPBRN indicated they wanted to participate in this research.  The research planning group met March and June 2005.  The proposal was approved by the Research Committee in September 2005.  The workshop to train these participants is projected for early 2006.  ADAF, CDCHF, and CDR are funding this research.

Evidence-Based Practice Research to Support Public Policy:

Project #1:  Dr. Linda Snetselaar was selected as the PI for the ADA involvement in the enhancement to the ongoing Medicare Disease Management Demonstration Project at the CARLE Clinics Foundation under the direction of Dr Cheryl Schraeder, PhD, RN.  The current program has 2,400 Medicare enrollees randomly assigned into usual care or treatment arms.  The project has 2 more years to go and they are looking for a way to enhance the nutrition and lifestyle components.  CARLE hired a RD to work with the RN as disease management specialists.  ADA is funding retrospective and prospective data collection and analysis of data to document the change in outcomes with the RD involvement.  Training was conducted in February and September 2005 and data collection started in Aril 2005.  CDR is funding this research.

Project #2:  We have signed an initial letter of intent Blue Cross Blue Shield of North Carolina to explore a similar collaboration on a three year research initiative to evaluate their new coverage of MNT and lifestyle case management by RDs.  The Principal Investigators are Dr Linda Snetselaar, Dr Gwen Murphy, Dr Don Bradley, and Dr Esther Myers.  The research will be conducted through the DBPRN and is anticipated to begin in February 2006. 

last updated: October 2005