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4/7/2016

2016 Clinical Nutrition Management DPG Symposium

Rosa K Hand, MS, RDN, LDMartin M Yadrick, MBI, MS, RDN, FAND

Integrating Academy Research Resources into Clinical Management Practice

Disclosures—Rosa K Hand

Employer-Academy of Nutrition and Dietetics

Grant Support—currentDPGs: CNM, DCE, RPGAgency for Healthcare Research and Quality

Grant Support—completedDPGs: DIFM, CNMInternational Food Information Council FoundationAmerican College of Sports MedicineAbbott NutritionConAgra Foods Foundation

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Disclosures—Martin M Yadrick

None

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Session Objectives

1. Describe the relationship between the Nutrition Care Process and Terminology and research and quality improvement efforts

2. Name and describe at least one Academy research resource

3. Describe how your facility could use ANDHII to collect data that would answer a question from administration.

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NCP

NCPT is the common thread

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ANDHII/DPBRN

EAL

Evidence Based

Nutrition Practice

Guidelines

Outcomes

ResearchNCPT/

ANDHII

Translational

Research

Positions, SOP/SOPP, &

Public Policy

Practice

Monitoring & Evaluation

Assessment

Diagnosis

Intervention

Practice

EAL: Evidence Analysis Library; NCP: Nutrition Care Process; NCP: Nutrition Care Process Terminology (formerly IDNT);ANDHII: Academy of Nutrition and Dietetics Health Informatics Infrastructure; DPBRN: Dietetics Practice Based Research Network; SOP-Scope of Practice/Standards of Professional Performance

NCP=Outcomes

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JADA August 2003

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NCP is at the

root

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What does this mean for you?

Substitute quality improvement for research

Use of NCPT=beginnings of outcomes tracking and outcomes management

Inputs and outputs are already definedYour job is to link and measure them

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Questions to Ask

At what rate are evidence-based or other guidelines/protocols being implemented?

What guidelines lead to better patient outcomes?

What strategies are successful at implementing guidelines or nutrition interventions?

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NCP

Implementation

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ANDHII/DPBRN

EAL

Evidence Based

Nutrition Practice

Guidelines

Outcomes

ResearchNCPT/

ANDHII

Translational

Research

Positions, SOP/SOPP, &

Public Policy

Practice

Monitoring & Evaluation

Assessment

Diagnosis

Intervention

Practice

EAL: Evidence Analysis Library; NCP: Nutrition Care Process; NCP: Nutrition Care Process Terminology (formerly IDNT);ANDHII: Academy of Nutrition and Dietetics Health Informatics Infrastructure; DPBRN: Dietetics Practice Based Research Network; SOP-Scope of Practice/Standards of Professional Performance

JAND April 2016

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Use research resources to answer

Use the chains concept to measure implementation

Use the chains concept to create smart statements for your EMR to increase use of guidelines

Statements can also be used to train students or have a discussion about the most important elements of a guideline to implement

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Staffing Study—Part 1

Project Staff:

Rosa K Hand, MS, RDN, LD, &

Jenica K Abram, MPH, RDN, LDN

Statistical Consultant:

J. Scott Parrott, PhD

CNM Planning Group

Barbara Jordan, MS, RDN, CDN

Susan DeHoog, RD, CD

Jessie Pavlinac, MS, RDN, LD, CSR

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Free implementation webinar on eatrightpro.org/dpbrnand CNM website

Patient and Encounter Characteristics Other activities

Mean Minutes

per RDN day

±SD

Median per

RDN day

Max minutes

per RDN day

Number of

RDN days

with

minutes>0

in category

Mean

minutes

among

those days

with any

minutes

Median

among

those

days

with any

minutes

Screening time 38.0±30.4 30 285 4071 42.0±29.2 35

Food Service

Activities

5.52±23.6 0 362 122 26.0±45.8 15

Outpatient 11.8±43.7 0 420 572 93.1±86.2 60

Meal Rounds 2.0±7.3 0 120 486 18.3±14.0 15

Patient Rounds 34.6±51.2 14 360 2344 66.4±53.9 50

Projects 19.3±42.4 0 430 1467 59.0±55.9 40

Support Activities 12.8±26.9 0 370 1804 31.9±34.4 22

Non-patient

meetings

20.3±37.9 0 360 1559 58.6±43.7 59

Student/Staff

Education

9.7±28.2 0 451 839 52.0±45.5 40

Research 18.5±20.2 15 240 3108 26.8±19.1 20

Communications 24.4±22.3 20 330 3800 28.8±21.5 25

Nonproductive Time 43.2±28.6 40 300 4180 36.4±27 44

Own Education 9.7±24.9 0 360 1058 41.3±36.5 30

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Project Partnership—Part 2

Project Staff:

Rosa K Hand, MS, RDN, LD, &

Jenica K Abram, MPH, RDN, LDN

Statistical Consultants:

J. Scott Parrott, PhD

Jim Lee, MSE

Planning Workgroup

Susan DeHoog, RD, CD

Anne Voss, PhD, RDN, LDN

Julie Grim, MPH, RD, LD

Debby Kasper, RDN, LDN, SNS

Wendy Phillips, MS, RD, CNSC, CLE, FAND

Susan Goolsby, MS, RD, LD

Jan Greer-Carney, MS, MBA, RDN, LD

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Method of Entering Data in EHR

3%

15%

57%

0%

1%

23%

26%

Don't Know

Don't Use Structured Screens

Both Narrative and Structured Data

NCPT Interface Maps to LOINC/SNOMED-CT

LOINC/SNOMED-CT used

Structured Screens Using NCPT

Structured Screens Using NCP

2014 (N = 460)

Please identify the means by which you enter data into your organizations EHR? (Select all that apply). 40

www.andhii.org

ANDHII’s Creator

Will Murphy, MS, RDNSr. Manager, Outcomes ResearchAcademy of Nutrition and Dietetics• Completed Dietetic Internship at Louis Stokes VA Hospital /

Case Western Reserve University• Certified Specialist in Data Science• Former Spinal Cord Injury Unit RDN at Memphis VA Hospital• Sr. Manager, Outcomes Research at the Academy of Nutrition

and Dietetics for 3 years• Conduct comparative effectiveness and outcomes research• Develop health informatics software to facilitate outcomes

management and research• Provide scientific commentary to Academy legislative and public policy

efforts• Develop computerized simulation-based dietetics education content

Patients need nutrition careOur care protocols work

Nutrition makes a difference

PROVE

ITwith ANDHII

• Your staff create useful nutrition care and patient outcomes data with every patient they see, but how much of that data is available for you to use currently?

• ANDHII puts you in charge of that data to get the charts and reports you need right when you need them without spending time reviewing charts

• Prove your nutrition point with ANDHII

Put Your Work to Work Use NCP Smarter and Faster

What’s a good diagnosis for above average TV/screen time?

What was the diagnostic term for poor adherence?

What are some common etiologies for Inadequate fat intake?

What lab test might help monitor Inadequate oral intake?

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Put Your Work to Work ANDHII’s impact on Time

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7 Minutes

Extra

3.5 Minutes

Extra

36 Minutes

Extra

KF6

Average Benefit : Burden ratio = 1.3

ANDHII Use Around the World

Popular Assessments Popular Diagnoses

Slide 32

KF6 Hi will --we noted that youare deleting the next 3 slides. I do however think the audience will be

wondering about ANDHIIs impact on time? So I would make sure you are prepared to address this or

Marsha suggested including only slides 34 and 35 but not 36. what do you thnk?Karen Ferrantella, 9/18/2015

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Popular Interventions New in ANDHII

No-cost access to ANDHII available for all RDNs and NDTRS thanks to CDR funding

Group Option� Use your staff’s ANDHII entries to make reports and graphs

� Set your own priority with on-demand reporting tools

� Improved continuity of nutrition care

Compliance Options

Who is a researcher?• Involvement in the conduct of research

� Study design, interpretation and analysis of data, authorship of presentations or manuscripts

• Does not include RDNs entering data into ANDHII with no other involvement

What makes information identifiable?• Individually identifiable health

information• 18 data categories in Privacy Rule

Rosa Handrhand@eatright.org

Marty Yadrickmyadrick@computrition.com

Andhii.org/infoandhii@eatright.org

Questions?

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