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Research Committee Report Spring 2006

The Research Committee is a joint committee for the Board of Directors and House of Delegates that addresses Strategic Goal 6: Impact the research agenda and facilitate research supporting the dietetics profession, and the House Of Delegates Spring 2001 Motion #6: Related to evidence-based practice and research in all settings.

Building Alliances for Research

The Research Committee has worked diligently to expand the ADA’s influence and visibility in research by building alliances with numerous research-oriented organizations and associations. The goal is to build alliances that will support ADA research priorities and the Association’s strategic plan. The Research Advisory Board (RAB), consisting of members from government, industry and non-profit organizations, met at FNCE and reviewed our research initiatives and our progress on the Evidence Analysis Library.

Dr. E. Myers and Dr. J. Fischer attended the 2006 International Life Sciences Institute in Puerto Rico on January 15 to 18, 2006. Dr. Esther Myers, Dr. Mary Hager and Dr. Phyllis Bowen were invited to a meeting with Dr. John Milner and Dr. Nancy Emenaker of National Cancer Institute to provide input on future research topics for NCI. In addition to the discussion during FASEB, a separate follow-up e-mail will be sent incorporating input from Dr. Linda Snetselaar.

Exploring Federally Funded Research Meetings

ADA is involved in three separate initiatives to support grant proposals for federal funding to support research meetings of interest to the Dietetic Profession. A dialogue has continued since 2000 about the possibility of a joint inter-society research meeting between various nutrition societies outside as well as within the ADA Research Committee and DPG. Following is a summary of the discussions from each of the areas:

Inter-Society Nutrition Research Meeting. The concept of a nutrition research meeting jointly held with the nutrition societies has been brought forward by ASPEN. A planning meeting was held in October 2004. The CEOs met subsequently to discuss a business plan. The proposal was submitted to NIH on November 1, 2005. ADA will be the lead organization in this effort. We have notification from the NIH project officer that our score was high enough to receive some funding ($20,000 versus the $60,0000 requested). Informally, the project officer indicated that other institutes MIGHT contribute more, but it would be later in the year (October to November timeframe). This will be too late for us to conduct the workshop in June 2007. Therefore, Dr. Tappenden is hoping to discuss this issue with Dr. Van Hubbard to find out if we can have a no-cost extension until June 2008 to wait for additional funds. We have had to release the June 7 to 9, 2007 reservation in San Diego, CA at the Hyatt Regency Islandia Hotel and Marina since ADA could not sign a contract guaranteeing the rooms (approximately $100,000) at this point.
“Making Healthy Eating Possible: Leveraging Both Food and Nutrition Science.” The Research Committee has discussed the concept of a research symposium focusing more on emerging research in the area of Health and the Food Supply. Dr. Linda Snetselaar completed a “mini-sabbatical” at ADA this summer and prepared an initial draft grant proposal. We are working with the Nutrition Section of IFT on this proposal. The target date for submission has been delayed indefinitely. However, there was renewed interest expressed at FASEB based on the joint session identifying the need to have more interaction between dietetics and food science.
Allied Health Research Roadmap. The Research Committee was contacted by allied health care organizations to discuss collaborative research meetings and advancing research. Dr. Carol Shanklin and Dr. Esther Myers attended their teleconference and meetings. ADA hosted their last meeting at the ADA headquarters on July 15, 2004. This group has discussed submitting a joint proposal to NIH or AHRQ funding for small conferences grant as part of the overall roadmap developed by this group for Allied Health. A formal letter of request for an alliance was submitted to the group in 2005 and ADA returned a letter of support. Dr. Deb Canter has replaced Dr. Carol Shanklin as the Research Committee representative. Proposal submission was originally targeted for 2006; however, the Ohio State University group indicated that they had detected a change in priorities and wanted to wait to submit. A meeting was conducted in March 2006 with Dr. Esther Myers attending in person and Dr. Deborah Canter joining by teleconference. This project appears to be moving VERY slowly with a re-discussion of the purpose and rethinking the previous discussion about potential agenda. The Ohio State University Group did tentatively agree to submit the concept to AHRQ for evaluation and a subgroup was convened to redraft the purpose, creating a plan for how the group will relate to each other (e.g., organizational structure of these associations) and potential timeline for moving forward. ADA did not offer to join the subgroup but did commit to remain involved in the process.

Research Strategic Goal

The Research committee is working on three processes that can be considered for incorporation into Family of Measures to measure our strategic goal related to research:

Review NIH and CSREES databases to identify studies that match ADA Research Priorities.
Review research published in the Journal of the American Dietetic Association to identify studies that match ADA Research Priorities. The Research committee reviewed several issues of the Journal independently and compared results. They determined that the best approach would be to have a mini-contract with a university that had graduate students who could consistently perform the review; however, would report to the RC for them to discuss and provide input into reviews. This was incorporated in the budget request for 2006 to 2007.
Create measure to reflect level of ADA funding for research.

Evidence Analysis (EA) to Support Evidence Based Practice

To meet the growing demand for ADA Evidence Analysis projects, three evidence analysis workshops were offered in Chicago in June, July and November 2005, and January 2006. At the present time, 96 ADA members have been trained as Evidence Analysts. The Evidence Analysis Library (EAL) was activated in September 2004 and the Evidence-Based Guidelines section was activated in August 2005. Results of evidence analysis utilization are being posted daily. From August to November 2005, the number of times the Web site was accessed averaged between 30,000 to 40,000 monthly, and from December 2005 to March 2006, the Web site showed an average monthly access rate of 14,000 to 16,000 times per month. The Disorders of Lipid Metabolism and the Major Recommendations for Disorders of Lipid Metabolism are the most popular destinations, and have been accessed 22,202 and 13,695 times, respectively, from August 1, 2004 to March 31, 2005. The next most popular pages are childhood overweight (9,470), critical illness (8,194) and measuring energy expenditure (7,178).

Since April 7, we have been sending out invitations for EAL registration at the rate of 250 per hour to all ADA members with an e-mail address and are monitoring the change in usage as well as the number of requests for assistance at the Member Service Center and SAR. Prior to sending out the e-mail invitations, 7,137 individuals had registered at the EAL Web site. In the first nine days of April (since sending out these invitations) an additional 14,000 members have registered for use of the EAL, bringing the total to 21,137.

Support for Public Policy Workshop

The PIA office has indicated that they will not need research summaries for the Public Policy Workshop as in the past.

Identification of Original Contribution Abstract Topics

The Research Committee has been notified of a change in this process and will be contacting the PPAC for clarification.

Planning FNCE Research Symposium

The Research Committee selected these topics: Use of Nutrient Data Base in Nutrition Research and Epigenetics and Dietetics. The Metabolic Syndrome and Cancer portion of the symposium, originally planned as a collaborative effort with Harvard Medical School, was cancelled in late January (as informed by PMK Associates) when they determined that it was not feasible to continue the collaboration.

Research Priorities

The Research Committee identified two potential topics for the first Research Grant from the ADAF Research Endowment along with key researchers to help clarify the RFA and also a topic for the Ann Hertzler Grant. In addition the Research Committee has outlined the process to update the ADA Research Priorities document that guides ADA decisions and input on research priorities.

Oversight of Association Research

The Research Committee continues to monitor progress and provide input on the following research projects:

DPBRN Descriptive Study
Critical Thinking in Measuring Energy Expenditure (CTIMEE)
Research to Support Public Policy
1. Obesity and Chronic Diseases – NC BCBS
2. CARLE Clinic Research Study
Nutrition Quality of Life
International Diabetes Outcome Study (IDOS)
Healthy Lifestyle Study
Family Nutrition and Physical Activity Screening Tool
Standardized Language—Three Research Applications
Validation of Nutrition Risk Assessment
Dietetics Measure/Index
Career Path Methodology Pilot
Researcher Survey

RESEARCH PROJECTS BEING CONDUCTED THROUGH DPRRN

Description: Dietetics Practice-Based Research Network (DPBRN)

Approximately 500 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 DBPRN Task Force met August 29 and 30 to plan 2005 to 2006 activities. Policies and procedures for the DPBRN were reviewed and forwarded to Research Committee and were approved. One member of the network, Lori Faulk, was nominated for membership to the oversight group and was subsequently approved by the Research committee. Dr. Linda Snetselaar’s contract for serving as the DPBRN Director was finalized in May 2005. The current projects being completed are the Descriptive Study (article being written now), Critical Thinking in Measuring Energy Expenditure (CTIMEE) (data collection to be completed by end of March 2006), North Carolina Blue Cross and Blue Shield, and Standardized Language validation (training to start project scheduled for February 11 to 13, 2006). The Diabetes DPG has agreed to fund a planning group to outline the testing of the Diabetes guidelines to be updated in Fiscal Year 2006 to 2007. This planning group meeting is scheduled for May 11 and 12, 2006. The DBPRN is funded by ADAF.

Descriptive Study

The descriptive study summarizes the practice characteristics of the 500 members who have completed the enrollment study and the 140 members that have completed the complete descriptive study. The statistics have been completed, the article drafted and is currently being reviewed. It will likely be submitted to the Journal as an “Of Professional Interest” article in Spring 2006.

Critical Thinking In Measuring Energy Expenditure (CTIMEE)

This prospective study through the DPBRN is designed to identify: a) the practical usability of the current appendix by Dietetic Practitioners (readability, content, organization) and b) the clinical judgment criteria used by Dietetic Practitioners as they determine which conditions and what type of patients they would measure RMR versus using estimation by formulas when the full information about accuracy and appropriate equipment are available. Forty DPBRN members have volunteered and been notified of selection to participate in the study. Each study RD will receive a MedGem device with supplies for 20 measurements. They will record their decisions to measure REE and return the MedGem device to the manufacturer at the end of the study. The protocol was approved by the Western Institutional Review Board. The training was conducted on April 8 to 10, 2005 at ADA headquarters. Of the 33 dietitians who were trained, five withdrew from the study for a variety of reasons. Four new dietitians were recruited in November and December 2005, and received training via Webinars. Data collection is underway now and the original participants should be completed by February 2005. The participants who started in January 2005 completed the study by the end of March 2005. This research is funded by ADAF and Healthetech.

Standardized Language (Nutrition Diagnosis) Validation (Phase II)

Dr. Evelyn Enrione and Dr. Linda Snetselaar are co-PIs for the research project being conducted through the DBPRN. The research entails recruiting pairs of dietitians (11 pairs) in the same institution/setting that will both independently assess a patient and determine a nutrition diagnosis. The goal is for each RD pair to evaluate 50 patients. Since the patients will be selected randomly, it is highly likely that not all nutrition diagnostic terms will be used in their research. However, it will provide insight into whether dietitians given the same information will come to similar conclusions. The training for the dietitians who are participating was held on March 11 to 13, 2006. This research is funded by CDR and ADAF.

EVIDENCE-BASED PRACTICE RESEARCH TO SUPPORT PUBLIC POLICY

Obesity and Chronic Disease—BCBS Research Studies

The Second EBPR Project is designed to explore outcomes from MNT for older individuals with obesity and multiple chronic diseases. These studies are being completed through the DPBRN. The Blue Cross Blue Shield of North Carolina has signed a letter of agreement to proceed and the contract is with their lawyers. The Duke University contract has been signed and the University of Iowa contract is in their contracting office. The Research Committee reviewed and provided input on the research proposal. The IRB submission to Duke was separated into two projects to facilitate their timely processing (one study being exempt that uses BCBS claims data and the other requiring signed consent from patients for RDs to collect data). The training outline and materials were completed and training was held during January and February via Webinar, with face to face training in March and April 2006. One additional training is scheduled for May 3 and 4. Depending on the recruitment, a June training may also be necessary. The benefit officially began for the majority of the beneficiaries in January 2006. Patient recruitment is targeted from March 2006 through September 2006. This research is funded by CDR.

OTHER ONGOING RESEARCH PROJECTS

Evidence-Based Practice Research to Support Public Policy

CARLE Research

The CARLE Research is designed as an add-on to the Medicare Outcomes Demonstration Project that will evaluate the inclusion of nutrition care by RDs for an expanded list of chronic conditions in an ongoing Medicare Disease Management Demonstration Project. The current program has 2,400 Medicare enrollees randomly assigned into usual care or treatment arms. The project has three more years to go and CARLE is now providing an enhanced nutrition and lifestyle component. CARLE has hired a RD to work with the RN as disease management specialists. ADA will fund the data collection and analysis of data to document the change in outcomes with the RD involvement. Dr. Linda Snetselaar was selected as the co-PI for the project funded by the ADA to work with Dr. Cheryl Schraeder from the CARLE Foundation. The proposal was approved by the CARLE Institutional Review Board in January 2005. The training for the research project was conducted in February, May, September and October 2005, with implementation of intervention and data collection to begin immediately afterward. Federal funding opportunities will be explored for a potential submission. The first paper that describes the methodology and baseline data has been reviewed by authors and is being updated for submission to the Journal in April 2006. Initial data from which a nutrition diagnosis is used with a specific medical diagnosis is available and is being evaluated for a potential “Of Professional Interest” article for the Journal sometime in fall 2006. This research is funded by CDR.

Nutrition Quality of Life (NQoL) (Phase I)

This 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 a 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 the February 2003 Journal. This was considered as a project to be developed for a future DPBRN research project. Initial work was funded by the ADAF.

International Diabetes Outcomes Study (IDOS)

The IDOS study will evaluate outcomes from implementing the ADA MNT Guides for Practice for Adult Type 1 and 2 Diabetes in Israel, Turkey and Lebanon. A coordinator and five dietitians in each country were trained (in December 2003, September 2004 and January 2005). The Guides have been translated into Hebrew, Turkish and Arabic. Abbott Laboratories has approved funding for glucometers and strips for the subjects for a one year period in all three countries. A site visit and additional training was conducted in Lebanon in September 2005. Israeli dietitians have enrolled all their patients and most of them have multiple visits. Lebanese dietitians are currently enrolling patients and had hoped to have all patients enrolled by March 2006. The Turkish dietitians are far behind in their recruitment and have indicated that they would like to withdraw from the study. We are exploring how to re-energize this part of the study, as there is one dietitian who has contributed to the patient population and works in a diabetes center. This is funded by ADAF.

Healthy Eating and Activity Study/Pediatric Research in Office Setting

ADA is collaborating with the 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 were recruited in early 2004. This study will include five practices in each of three arms: Control (usual care pediatrician), Minimal (pediatrician five min MI) and Intensive (pediatrician and RD MI). Subjects are being enrolled and participating in the study now. A follow-up to this study that will involve five regions throughout the United States is being proposed for NIH funding. The proposal was re-submitted in November 2005. The paper from the pilot study has been drafted and is being reviewed for submission to AAP. The initial pilot study was funded by CDC and ADAF.

Family Nutrition and Physical Screening Tool

The initial proposal for development and validation of a short screening tool uses family characteristics most closely linked to development of childhood obesity was 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, recently resubmitted in April 2004 to MCHB for review. The PIs are Greg Welk (Iowa State University) and Esther Myers (ADA). Patricia Crawford and Lorrene Ritchie (UC Berkeley Center for Weight and Health) and Karen Peterson (Harvard) are consultants on the research project. A draft article summary has been prepared for the Journal. Based on evidence analysis for family nutrition and physical activity factors associated with changes in prevalence of overweight in children. A revised proposal as a pilot project was submitted to NIH in November 2005 under the R-03 funding program announcement of NIDDK. Initial work was funded by the Ann Hertzler Fund of the ADAF.

Standardized Language

Dr. Pam Charney’s research, which used online cases to identify differences in the use of the terms with entry level, beyond entry level and advanced practitioners, is completed. In addition, eight nutrition diagnosis-defining characteristics were evaluated. This research was highlighted at the 2005 FNCE session and presented to the Nutrition Care Process/Standardized Language Committee in December. Research on nutritional diagnoses in practice was one of the topics selected by the DBPRN task force for development this year (below) and the nutrition diagnoses were included as data elements in the CARLE project (below) as well as the NC BCBS project (below). This research was partially funded by ADA.

Standardized Language (Nutrition Diagnosis) Content Validation (Phase I)

Dr. Evelyn Enrione and Dr. Linda Snetselaar are co-PIs on a survey research project that will ask dietitians to evaluate the definitions and defining characteristics of all 65 nutrition diagnosis. A methodology similar to Dr. Pam Charney’s research will be used to evaluate the results. These results will be incorporated into the Third Edition of the Nutrition Diagnosis publication (2007). Surveys were mailed to the approximately 200 ADA members who volunteered for the PNND and, to date, 40 have been returned. The survey takes approximately three hours to complete. Incentives have been offered.

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. Materials were posted on CDCHF with facility enrollment beginning during May 2004. Ten dietitians have enrolled and begun data collection at this point. This is funded by the DPG.

Dietetics Measure

The Research Committee reviewed the methodology and results, and identified the most appropriate use of the data. The report from Blackstone will be reviewed in February 2006 prior to submitting the full annual report to the BOD for orientation in June 2006.

Career Path Pilot Research Project A subgroup of the Research Committee solicited and reviewed the application received to conduct a pilot project, to conduct a literature search and determine research methodology for exploring career path options for dietetics professionals. Kansas State University was awarded the project in May 2005 and updates have been received regularly. The final report should be available by May 2006.

Researcher Survey

An update to the ADA member researcher survey that was conducted in 2001 is being planned again for this year. A subgroup of the Research Committee has reviewed the survey instrument and is suggesting minor changes. A timeline for completion of the research by May 1 is being developed. The results will be compared to the previous survey and submitted for publication in the Journal in spring 2007.

Submitted by Joan Fischer, PhD, RD and Esther Myers, PhD, RD, FADA

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