Research Activity
Dietetics Practice-Based Research Network (DPBRN)
Over 637 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; ADA; NERCOA of Northeastern University; Weight Management DPG; Consultant Dietitians in Health Care Facilities DPG; Diabetes Care and Education DPG; and Clinical Nutrition Managers DPG). In addition to enrollment, 264 members have completed the Descriptive Study. Six projects have been completed: Descriptive Study; Critical Thinking in Measuring Energy Expenditure; Standardized Language: Nutrition Diagnosis; Pilot study for Nutrition Quality of Life validation; and Feasibility testing of two toolkits for Evidence-Based Guidelines for Nutrition Practice. One large project is underway — BCBS North Carolina MNT Utilization for Overweight Individuals. Four more projects are in the planning process: Field testing Diabetes Evidence-Based Nutrition Practice Guidelines; Validation of Nutrition Quality of Life; Clinical Productivity and Clinical Staffing Study; and Clinical Validation of Nutrition Risk Assessment.
Evidence-Based Practice
To meet the growing demand for ADA Evidence Analysis (EA) projects, 15 evidence analysis workshops have been offered in Chicago since 2002, with over 170 members trained as analysts. An Evidence Analysis Library (EAL) was activated in September 2004; the Evidence-Based Guidelines section was activated in June 2005; the toolkit was offered for sale in July 2006; and non member subscriptions were offered in September 2006. Results of evidence analysis are being posted daily from the 24 ongoing projects funded by ADA, CDR, DPGs and external funders. The EAL passed the 2,000,000 page view mark in August 2007; 3,000,000 page views in December 2007; 4,000,000 in June 2008; and has over 4,454,500 page views as of September 25, 2008. Individuals from over 122 countries have accessed the EAL. Over 2700 research articles have been evaluated and included in the ADA EAL. Other value-added products have been developed for sale (e.g. Educators module.)
- Nutrition Quality of Life (NQoL) (Phase I):
The NQoL was developed by Dr. Judith Barr and Dr. Gerald Schumacher from Northeastern University with funding from ADAF (Novation and Abbott Laboratories). Focus groups with clients and dietitians led to a draft instrument to measure the unique contribution of RDs to a client's ability to "cope" with their nutritional considerations. The NQoL instrument was presented at FNCE 2001 and at Nutrition Week in February 2002. The article summarizing the development was published in February 2003 JADA. The Weight Management DPG funded a development planning meeting which was held in March 2007, and the pilot study jointly funded by the DPG and NERCOA from Northeastern University was completed summer. An NCI grant proposal was resubmitted in November 2007 and a revision submitted in November 2008. The proposal is also being used to seek funding from other sources. - 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 Lebanon. A coordinator and five dietitians in each country were trained (in December 2003 and September 2004). The guides have been translated to Hebrew, Turkish and Arabic. Abbott approved funding for glucometers and strips for the subjects for a one year period in all three countries. Data has been received from all three countries and is now being analyzed, results are being presented at FNCE and a manuscript being prepared. The final meeting of RD participants was held in June 2008 in Amann, Jordan. Research project is funded through the ADAF Wimpfheimer-Guggenheim Fund for International Exchange in Nutrition, Dietetics and Management. - BMI2/Healthy Lifestyle Research Study:
The Motivational Interviewing training for 11 RDs, 10 pediatricians, and 12 researchers was held in 2002 with Ken Resnicow to support the Healthy Lifestyle Research Study. The pilot study concluded in 2004 and a paper published in Archives of Pediatric and Adolescent Medicine. RD attendees were involved in developing the pediatric CDR workshop. A follow-up four year research project, BMI2, was funded by NIH and started in 2008. - Family Nutrition and Physical Screening Tool:
The initial proposal was 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 was supported by The Ann Hertzler Fund and Healthy Weight for Kids. It was submitted but not funded by MCHB and NIH. - 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. The CDHCF DPG funded the proposal preparation ($5,000) that was submitted to AHRQ but unfunded. In Spring 2004, a pilot data collection was incorporated into revisions of the proposal. Materials were posted on CDCHF with facility enrollment beginning during May 2004. Fifteen dietitians are enrolled and are collecting data. Data is being analyzed and terms matched with current NCP/standardized language terms. The CDHCF has decided to fund a second planning conference to revise the AHRQ application for resubmission in 2008-2009. - Annual Outcomes Grant:
The Research Committee recommended that an ultimate goal for ADA would be to establish an ongoing annual outcomes grant to be supported by the ADAF Research Endowment fund. The first $35,000 grant was awarded in FNCE 2007 to Karen Chapman-Novakofski, RD, PhD, Professor of Nutrition, in the Department of Food Science and Human Nutrition, Division of Nutritional Sciences, and Department of Internal Medicine, College of Medicine, at the University of Illinois at Urbana-Champaign. - The HOT project:
Healthy Outcomes for Teens. The HOT project [Healthy Outcomes for Youth] intends to offer an innovative, interactive, youth-participatory treatment for adolescents at risk for type II diabetes. The HOT project will develop and test podcasts (web-based audio and video viewed on MP3 players or computers with internet access) and interactive skill-building web games to promote independence in self-care of adolescents with type II diabetes or at risk for type II diabetes. - Standardized Language: Reliability of Nutrition Diagnostic Terminology
Dr. Evelyn Enrione worked with ADA during her sabbatical (2005-2006) to develop the research protocol and conduct the first of the descriptive studies documenting how the nutrition diagnosis terms are used in practice. Ten pairs of dietitians from the DPBRN were trained and began data collection in March 2006 and completed in January 2007. Nine dyads completed the data collection, and data analysis is being completed in collaboration with the nursing group at University of Iowa. ADAF, CDHCF DPG, 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 was midway completed 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 and data collection started in April 2005. Partial data is available for the two-year period from April 2005 to May 2007 for healthcare indicators. Data from the NCP and from RDs is not yet available. Data analysis will begin again in summer 2008. CDR is funding this research.
Project #2: A second research project was begun in summer 2005. BCBS of North Carolina and ADA are collaborating on a multi-year initiative to evaluate health, utilization and economic outcomes of MNT and lifestyle case management coverage for beneficiaries with obesity. The principal investigators are Dr. Linda Snetselaar, Dr. Gwen Murphy, Dr. Don Bradley and Dr. Esther Myers. Over 40 RDs were recruited and trained. Patient recruitment started in April 2006 with the data collection ending in 2009. At this point 597 patients have been enrolled and over 2354 visits provided. ADA, CDR and BCBS NC are funding the project.
- 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 was midway completed 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 and data collection started in April 2005. Partial data is available for the two-year period from April 2005 to May 2007 for healthcare indicators. Data from the NCP and from RDs is not yet available. Data analysis will begin again in summer 2008. CDR is funding this research.
- Clinical Staffing and Productivity Study (CSPS):
The Clinical Nutrition Managers Dietetic Practice Group has funded the planning and partial funding for the first year of a two year project intended to evaluate existing staffing levels in 80 healthcare facilities (either an ICU or Medical-Surgical units), apply zero-based staffing methodology to half of the group, and then evaluate impact of new staffing levels on key nutrition care process and outcome measures. A staffing model will be created based on the staffing levels evaluated using defined healthcare demographic/utilization measures (bed occupancy, facility type/size, etc). Initial reviews by Research Committee were submitted in April 2008 and revisions to protocol are underway.