7/21/2014. Opportunities for the RDN in Patient-Centered Medical Neighborhoods. Christopher Taylor, PhD, RDN, LD

Transcription

1 Welcome to the COPE Webinar Series for Health Professionals! July 23 rd 2014 webinar: Opportunities for the RDN in Patient-Centered Medical Neighborhoods Time: 12 noon 1 PM EDT Moderator: Rebecca Shenkman, MPH, RDN, LDN Program Manager MacDonald Center for Obesity Prevention & Education Handouts of the slides are posted at: MacDonald Center for Obesity Prevention and Education (COPE) Goals Provide Continuing Education Partner with agencies and organizations Participate in Research Enhance Education Opportunities for the RDN in Patient-Centered Medical Neighborhoods Christopher Taylor, PhD, RDN, LD Objectives: Learner will be able to: 1. Describe the implications of projected changes in dietetics and the health professional workforce due to health care reform. 2. Identify opportunities for dietetics practice within the Patient-Center Medical Home and the Patient-Centered Medical Neighborhood. 3. Describe the role of technology-innovations to support shared communications between health care professionals. Credits: Notice: This webinar provides 1 contact hour for nurses and 1 CPEU for dietitians. Suggested CDR Learning Need Code: 3010, 4010, 6010; Level 2. Villanova University College of Nursing Continuing Education is an accredited provider of nursing education by the American Nurses Credentialing Center. Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration. 1

2 DISCLOSURE Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products displayed in conjunction with an activity. Opportunities for the RDN in Patient-Centered Medical Neighborhoods Christopher A. Taylor, PhD, RDN, LD Associate Professor of Medical Dietetics Associate Professor of Family Medicine DISCLOSURE Board Member/Advisory Panel The Ohio Board of Dietetics Research Dietetics Practice Group Employee The Ohio State University Research Support The US Department of Agriculture National Institutes of Health Abbott Nutrition Agency for Healthcare Research and Quality Research Collaboration Viocare, Inc. 2

3 OBJECTIVES Describe the implications of projected changes in dietetics and the health professional workforce due to health care reform. Identify opportunities for dietetics practice within the Patient-Center Medical Home and the Patient-Centered Medical Neighborhood. Describe the role of technology-innovations to support shared communications between health care professionals. Presentation Overview Health Crises in the US Role of Healthy Eating in Health Influencers of Food Choices Driving Effective Changes Technology s Role in Fostering Change Technology s Role in Fostering Communication A Case Study for Partnership for Health Eating Barriers and Opportunities

4 A clearer picture of need developing Growing US population and their waistlines Rippling effects of morbidity and mortality US has some of the poorest health outcomes of industrialized countries Lifestyle behaviors anchored as the cornerstone of prevention and treatment Key evidence-based guidelines Primary, secondary or tertiary Drivers of Food Choices Taste Variety Energy density Physiology Food Purchases Health Cost/ Access Conveni ence Addressing Consumer Needs Seeking the magic bullet Misinformation Nutrition Facts have a shelf life of two years Sources of nutrition information I researched this Translation: I Googled it. Too many voices Celebrity experts abound Dr. Katz Excerpt 4

5 Dr. David Katz Blog Entry The Patient-Centered Medical Home Evolution of the health-care system Opportunities to more fluidly provide services a patient needs Guidelines and grading based on infrastructure Not specific requirements on WHAT services to be provided The restaurant of healthcare Barriers to Getting Help Healthy People 2020 has established a goal of 15.2% of physician visits that include counseling about nutrition or diet (12.2% in 2007) 1 Primary Care Physicians lack training, time to foster behavior change 2-4 The current health care system does not have a funding and reimbursement model for dietary counseling The Affordable Care Act includes provisions for lifestyle behaviors and prevention Dietary counseling visits are direct consumer costs 5

6 Primary Care to address lifestyles? Patient Centered Medical Neighborhood A major challenge at facilitating behavior change is the efficient formative assessment of current behaviors Technology presents an opportunity to optimize the time investment in collecting and analyzing dietary intake data to provide meaningful, detailed reports. NIH grant Connecting OSU Family Practice with Retail RDs using technology Addressing Dietary Counseling Needs Many retail locations and community agencies currently provide many health-related services independent of healthcare Clinician responsibility to the payer Cross-disciplinary communications to outside providers remains a challenge 6

7 Technologies Enabling Role Our Goals Increase access of primary care patients to dietary counseling Improve RDN efficiency Close the communication loop between PCMN and PCMH Models for Testing Effects Key is linking resources Technology provides opportunities to close the loop Challenges of EMR integrations Identify Patients in Need Referral through EMR Online Dietary Patterns Assessment Retail RD counseling Session Tracking through Documentation Reporting outcomes back to Primary Care 7

8 Step 1: Identify Patients Vast majority of prevention and chronic disease management occurs within the primary care setting We developed a system to enter a referral into the EMR for retail RD nutrition counseling. PCP response has been relatively positive Step 2: Enhance Assessment for Greater Personalized Counseling What are you in for? Gather specific information about PCP concerns through referral Use technology for enhanced assessment prior to visit to maximize counseling time with client Minimize client burden and RD assessment analysis burden How to Enhance RD Efficiency The most effective counseling is based on an individual s needs A challenge RDs face is the ability to collect an accurate picture of dietary patterns AND nutritional adequacy Delicate balance between detailed and expeditious Detailed analysis requires time and resources; lack patterns Quick assessments lack details of adequacy Response needs to be targeted and actionable 8

9 Nutritional Assessment Techniques Food records 24 hour diet recalls Questionnaires/Surveys/ Screeners Food Frequency Questionnaires (FFQ) Metabolic feeding study Technology Paper Interviews Tape recorders Scales Observation Native computer software for data entry Photos Web-based Mobile Initial PDA Work with USDA Weighed Food Record Technique - NESSy 9

10 The ebutton The device is unobstructive Advanced electronic design Summary of major activity during a day Food portion size measurement using virtual reality Food volume measurement using an optical reference produced by the device Mobile Telephone Food Record (mpfr) System Zhu F et al. IEEE J Sel Top Signal Process Mobile Phone Image Recognition System 10

11 Web-based FFQ Dietary Assessment Design enables capture of accurate 90 day dietary history in ~20 minutes Based on the Fred Hutchinson validated Food Frequency Questionnaire (Women s Health Initiative ) Content based on eating trends and behaviors of typical American diet Uses food & beverage portion size images for increased assessment accuracy (over 1,200 images) Immediate analysis of over 140+ nutrient and food components Nutrient Profile Report Multiple Report Formats for Personalized Plans Summary (patient/consumer) Diagnostic (physician/dietitian) Detailed educational/tutorial (patient/consumer/dietitian) Comparative (assessment 1 to assessment n) 11

12 Top Nutrient Foods Tutorial Step 3: Document the Visit Electronic medical record access commonly a challenge outside of health care Need capability to accurately, efficiently and easily document the visit Built a system based on the Nutrition Care Process to capture all key aspects Demonstrates the extensive nature of assessment and counseling The RD s PCMN Charting Portal 12

13 The RD s PCMN Charting Portal The RD s PCMN Charting Portal The RD s PCMN Charting Portal 13

14 Patient Instructions Report Goals Patient Instructions Step 4: Close the Communication Loop The function of the PCMN is to enhance care in collaboration with resources outside of the medical home Key Nutrition Care Process elements are to be summarized and shared back to PCP Reports are generated with the RD s notes and a brief dietary report Don t send me a novel. I won t read any more than 2 pages. Physician s Report Page 1 14

15 Physician s Report Page 2 Opportunities and Caveats Coding change Identify provider Rx for assessment PCP priorities Referral through EMR Online Dietary Patterns Assessment Timing of assessment prior to RD visit Review of report ahead of visit Close loop Allows PCP to reinforce lifestyle change Barrier to EMR integration Reporting back to Primary Care Session Tracking through Documentation Charting mechanism for RD clinical notes Establishes goals and intervention Referral through the EMR Barriers to implementation Physician training and utilization Challenges in implementation Referral through EMR Reporting back to Primary Care Online Dietary Patterns Assessm ent Session Tracking through Documen t-ation 15

16 Impacts of Technology on RD Efficiency minutes spent review FFQ Assessment Education Goals Tours Pre-Assessment Control Manuscript in Development Depth and Diversity of Education 3.0 Depth Score (1-4) Pre-Assessment Control Manuscript in Development Closing the Loop Reporting back to the Physician Developing a report for the Primary Care Physicians Integration into the EMR From the outside, in Opportunities for reinforcement instead of counseling Make it something they can understand EER??? 16

17 PRACTICE APPLICATIONS Diet has a profound impact of adding years to life and life to years Obtaining dietary counseling is difficult within the structure of the current health care system Technology has the capacity to enhance the outcomes for patients by connecting environments and improving efficiency Detailed assessment to promote concrete and actionable counseling sessions Fosters communication for the management of primary care patients Effective continuity of care will require RDNs to communicate effectively with patients and the coordinating providers References US Department of Health and Human Services. Nutrition and Weight Status. Available at: spx?topicid=29 Access 2014, Pomeroy SE, Cant RP. General practitioners' decision to refer patients to dietitians: insight into the clinical reasoning process. Aust J Prim Health 2010;16: PubMed Wynn K, Trudeau JD, Taunton K, Gowans M, Scott I. Nutrition in primary care: current practices, attitudes, and barriers. Can Fam Physician 2010;56:e109-e116. PubMed Visser F, Hiddink G, Koelen M, van BJ, Tobi H, van WC. Longitudinal changes in GPs' task perceptions, self-efficacy, barriers and practices of nutrition education and treatment of overweight. Fam Pract 2008;25 Suppl 1:i105-i111. PubMed Evaluations and CE Certificates Everyone who has completed the webinar will be ed a link to the evaluation. The will be sent to the address that you used to register for the webinar. Please complete the evaluation soon after you receive the . The evaluation does expire after 3 weeks. Once expired, you cannot obtain a certificate. Once the evaluation is completed, the CE certificate will be ed separately within 2 business days. 17

18 COPE s August Professional Webinar Kristen M. Beavers, PhD, MPH, RD Weight Management for Menopause and Beyond Date: Wednesday August 13 Time: 12:00PM 1:00PM EDT CE Credit: 1.0 contact hour, 1.0 CPE To register, go to villanova.edu/cope and click on Webinar Series Questions and Answers! Moderator: Rebecca Shenkman, MPH, RDN, LDN cope@villanova.edu Web site: villanova.edu/cope To receive monthly s on upcoming COPE events, please join COPE s Contacts on the web site. Thank you for your time and interest. 18