measuring dietetic practice (dec 2011)

Medicine, Nursing and Health Sciences

Measuring Dietetic Practice for Obesity

Developing data-reporting tools for dietitians

Melanie Voevodin, PhD CandidateDepartment of MedicineCentral Clinical School

13 December 2011

With Paul Komesaroff

Outline of Presentation Explanation of concepts Introduction Randomised controlled trial A Plan [before the RCT] Cross-sectional survey Retrospective Audit Progress to date Questions and challenges

13th December 2011Measuring Dietetic Practice for Obesity (MDP-O) Confirmation Presentation 2

Dietitians One of 14 ‘Allied Health’ Tertiary trained; evidence-based (medical model) About 3500 dietitians in Australia Employed in

Hospital (50%) Primary and community care (50%)

Experts in the relationship between food and disease


Concepts Introduction RCT Plan Survey Audit ChallengesProgress

Obesity‘Obesity’ = BMI >25kg/m2

One in three adults are BMI >25kg/m2

Trend of increase (despite investment $)Cluster in householdsGenetics; women of childbearing ageBehavioural economics: choose now, change later


Concepts RCT Plan Survey Audit ChallengesProgressIntroduction

Dietetic Practice for Obesity Dietitians can influence behaviour Takes time and effort in counseling (60min consult) Evidence-based best practice guidelines Potentially cost-effective


How effective is dietetic practice for obesity?


Dietetic Practice for Obesity


Limited dataDietitians do not have a reporting system

for consistent and accurate data recording

No data. No problem.…but no solution


BackgroundDietitians are well-placed to make a measurable contribution to Australia’s health

Dietitians do not have a reporting system for consistent and accurate data recording



Aim and ObjectiveInvestigate current data collection and reporting practices of dietitians providing a service for obesity

To develop, and then test, a data-recording and reporting system for the purpose of measuring dietetic practice for the treatment and management of obesity (MDP-O)



HypothesisDietitians who record data, and then have those data analysed and reported back to them, achieve better weight loss for their clients compared with dietitians who do not have data reported back to them

To test hypothesis: cluster randomised controlled trial



Randomised Control Trial


To test the hypothesis:Dietitians will be asked to use the data-recording tool on all new clients over a 10 month periodAll data will be analysed and reports preparedThe test group get their report backThe control group will notWeight loss expected to be greater in the test group


Randomised Control Trial


Concepts RCT Plan Survey Audit ChallengesProgress

Dietitians

Data recording

tool

20 weeks using the tool

Test group receives report

(control does not)

20 weeks using the tool

Introduction

Compare change in

weight for test vs control

?

?

Cross-sectional Survey

Retrospective Audit

Plan


Review of current practice

Initial tools and guidelines


Retrospective Audit

Updated tools and guidelines

Dec 2011 Randomised Control Trial


Cross-Sectional SurveyParticipantsDietitians providing a service for obesity (n=1000)Anywhere in Australia

Online 15 minute anonymous surveyNovember 2011n=200



Cross-Sectional SurveyObjective is to describe:Dietetic services for obesityVariations in service delivery (process)Variations in intervention (process)Factors influencing practice (process)Data recording and reporting practicesCompare these findings to model data-recording tool



Retrospective AuditParticipantsTwo dietitians submitting paper records of ten years of private practice service for obesityEach dietitian contributing about 600 complete episodes



Retrospective AuditObjective is to:Determine effectiveness of dietetic services for obesityExplore relationships between process and outcomeDescribe dietitians data recording and reportingCompare these findings to model data-recording tool



Progress to Date





Retrospective Audit




Challenges





Retrospective Audit



Concepts RCT Plan Survey Audit ChallengesProgress

End PhD

Introduction

ChallengesGetting the right treatment to the right person at the right time…

How to record behavioural intervention



20

SupervisorsPrevious supervisory team September 2010-2011

Professor Helen TrubyHead of Department Nutrition and Dietetics, Monash

Associate Professor Terrence HainesDirector, Allied Health Research Unit, Monash

Dr Claire PalermoSenior lecturer, Department of Nutrition and Dietetics, Monash

From November 2011 Professor Paul Komesaroff

Director, Monash Centre for Ethics and Medicine in Society

13th December 2011Measuring Dietetic Practice for Obesity (MDP-O)

Data-recording tool


measuring dietetic practice (dec 2011)

Health & Medicine