Nutrition Interventions to Improve Quality of Care Godfrey C. Xuereb Public Health Nutritionist Caribbean Food & Nutrition Institute (CFNI) Specialised Centre of the Pan American Health Organisation / World Health Organisation II PAHO-DOTA Workshop on Quality of Diabetes Care Diabetes Research Institute (DRI), University of Miami 14–16 May 2003

Medical Nutrition Therapy (MNT) Nutrition is accepted as a cornerstone of diabetes management. MNT is a medically necessary and cost-effective way of managing diabetes. II Workshop on Quality of Diabetes Care, Miami, May 2003

Medical Nutrition Therapy Principals Maintenance of near-normal blood glucose levels. Achievement of optimum lipid levels. Maintenance of attainment of reasonable weight. II Workshop on Quality of Diabetes Care, Miami, May 2003

Medical Nutrition Therapy Quality Health Care today requires Consistently applied evidence-based care that leads to positive outcomes for most patients. DCCT described the benefits of an expanded role for dietitians and included close alliances with team members and active involvement in monitoring glucose levels and adjusting insulin doses. II Workshop on Quality of Diabetes Care, Miami, May 2003

Medical Nutrition Therapy Nutrition Practice Guidelines have been developed and field tested: Describe responsibilities. Guide practical decisions. Promote self-management training. Define state-of-the-art MNT based on available scientific evidence and experience of experts. Practice guidelines improve blood glucose when applied in the field. II Workshop on Quality of Diabetes Care, Miami, May 2003

Source: Franz M.J. et al. (1995) J Am Diet Assoc 96 (9): 1009-1017. II Workshop on Quality of Diabetes Care, Miami, May 2003

Prioritising Nutrition Strategies Facilitating Behaviour Change Accurate nutrition information is essential. Information alone is not enough to change behavior. Several counselling and educational strategies are likely to improve the patient’s ability to apply nutrition recommendations. Readiness to change. Effective teaching and communication skills. Focusing on behaviour change. II Workshop on Quality of Diabetes Care, Miami, May 2003

II Workshop on Quality of Diabetes Care, Miami, May 2003 MONTSERRAT SURINAME II Workshop on Quality of Diabetes Care, Miami, May 2003

Professional to Population Ratio (Government service only) Source: CFNI Study on Human Resources in the Caribbean – 2000. II Workshop on Quality of Diabetes Care, Miami, May 2003

Sample *Additional 10% selected for these countries. II Workshop on Quality of Diabetes Care, Miami, May 2003

Key Findings - 1 II Workshop on Quality of Diabetes Care, Miami, May 2003

Key Findings - 2 II Workshop on Quality of Diabetes Care, Miami, May 2003

Key Findings - 3 II Workshop on Quality of Diabetes Care, Miami, May 2003

Quality of Care Clinical Indicator Comprehensive practice guidelines and/or standards of care are followed and result in adequate control of blood glucose. II Workshop on Quality of Diabetes Care, Miami, May 2003

Quality of Care Process Criteria Dietitian completes comprehensive history to assess health and nutritional status. Dietitian plans & instructs patient in appropriate nutrition intervention, including moderate exercise, as tolerated, to promote control of blood glucose and lipid levels and appropriate weight loss. II Workshop on Quality of Diabetes Care, Miami, May 2003

Quality of Care Process Criteria Dietitian documents patient’s comprehension, motivation and likelihood of adherence to treatment plan. Dietitian documents plans for monitoring and follow-up. Dietitian documents coordination of care with primary care provider and appropriate nursing staff as needed. Dietitian reinforces and monitors symptoms of hypoglycaemia and hyperglycemia. II Workshop on Quality of Diabetes Care, Miami, May 2003

Quality of Care Outcome Criteria Patient’s blood glucose level decreases at least 10% within 2 weeks of initial visit. Patient’s glycated HBA1c levels approach normal within 3 months of initial visit. Patient’s blood lipid levels approach normal within 2 months of attaining control of blood glucose levels. Patient’s dose of medication decreases over 6 weeks on appropriate nutrition treatment plan. II Workshop on Quality of Diabetes Care, Miami, May 2003