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Know your worth
Sue Kellie
Deputy chief executive/Head of
professional policy
The British Dietetic Association
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Aim and content
To encourage dietitians to systematically
define the outcomes you deliver for service
users, the dietetic service, the organisation
and the Health and Social Care system
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Content
• The presentation covers
– Dietitians contribution to meeting priorities
– Defining clinical outcomes
– Other types of outcomes
– Key points about outcomes
– Practice
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Healthcare priorities
• Quality and outcomes inc cost
effectiveness
• Productivity
• Prevention, health promotion and earlier
intervention
• Long term conditions
• Frail older people
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Outcomes
• What is the purpose of measuring
outcomes?
• What is an outcome ?
• Whose outcomes?
• What do you measure?
• How do you measure ?
• How is it being reported?
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Outcomes
• Change in the health of an individual,
group of people or a population which is
attributable to an intervention, or series of
interventions Equity and Excellence DH 2010
• Donadebian includes quality of life, length
of stay, reduction in readmissions, costs,
knowledge and satisfaction
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What can you measure
• Clinical, biochemistry, anthropometry
• Symptoms,
• Patient experience, patient focussed
• Knowledge, confidence, mental health
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Generic Outcomes
• Useful and practical information
• Confidence in using the information
• Changes to diet
• Recommend the services
Nottingham University Hospitals Dietetics Today, July 2014
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Measuring Outcomes
• Meaningful and relevant to practice
• Measurable
• Simple
• Systematic
– Collected routinely in practice
– Sampled
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Components of Assessment
• ABCDE
– Anthropometry
– Biochemistry
– Clinical/physical
– Dietary
– Environmental/behavioural/social
– Patient focussed goals and outcomes
(what matters to me)
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Components of a Diagnosis
The Problem
The alterations in the client/group/populations’ nutritional status.
Aetiology
The related factors are those factors contributing to the existence of, or maintenance of pathophysiological, psychosocial, situational, developmental, cultural, and/or environmental problems.
Signs and Symptoms
The defining characteristics are a cluster of and objective signs and symptoms established for each nutritional diagnosis.
The defining characteristics are gathered during the
assessment phase and provide evidence that nutrition
related problem exist
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Diagnosis
• Mrs B (age 50) exhibited symptoms of weight
loss, loose stools, anaemia
Investigations led to a diagnosis of coeliac
disease. She has now been referred to you.
She is anxious, very concerned about her
weight and anaemia. Dietary assessment
indicates a very restricted diet of white fish,
no carbohydrate, some vegetables and fruit
and boiled sweets
• Develop a diagnosis.
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Diagnosis • Aetiology
– little understanding of coeliac disease and
fear of eating
• Signs and symptoms
– Restricted diet with intake approx 50% of
standard, anaemia (Hb 9) and weight loss of
10% in last 4 months, BMI 27
• Diagnosis
– Need for nutrition education
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Plan
• Outcomes
– Understanding of gluten free diet
– Confidence in managing gluten free diet
• Goals
– Meet nutritional requirements
– Removal of gluten from diet
– Symptom free (patient focussed)
– Improved clinical indicators
• Plan
– Nutrition education individual and group
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Outcome
Knowledgeable, confident
patient
Anthropometry
Weight
Environment
Confidence
Knowledge
Biochemistry
Hb
Patient focussed
Quality of life
Dietary intake
Gluten free
Balanced nutrition Clinical /symptoms
Bowel movements
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Challenges
FEAR
It’s too big & difficult
Do we have the tools ?
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Why we should
Improve your practice
Efficiency & effectiveness
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