Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
4/7/2016
1
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
4/7/2016
Disclosures—Martin M Yadrick
None
4/7/2016
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.
4
NCP
NCPT is the common thread
5
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
6
4/7/2016
2
7
JADA August 2003
8
9 10
NCP is at the
root
11
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
12
4/7/2016
3
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?
13
NCP
Implementation
14
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
15 4/7/2016 16
4/7/2016 17
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
18
4/7/2016
4
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
20
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
23
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
4/7/2016
5
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?
4/7/2016
6
Put Your Work to Work ANDHII’s impact on Time
32
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
4/7/2016
7
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 [email protected]
Marty [email protected]
Andhii.org/[email protected]
Questions?
40