Measuring Dietetic Practice (Dec 2011)

Medicine, Nursing and Health Sciences
Measuring Dietetic Practice for
Obesity
Developing data-reporting tools for dietitians
Melanie Voevodin, PhD Candidate
Department of Medicine
Central 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
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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
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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 households
Genetics; women of childbearing age
Behavioural economics: choose now, change later
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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
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How effective is dietetic practice
for obesity?

Dietetic Practice for Obesity
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Limited data
Dietitians do not have a reporting system
for consistent and accurate data recording
No data. No problem.
…but no solution

Background
Dietitians 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
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Aim and Objective
Investigate 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)
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Hypothesis
Dietitians 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
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Randomised Control Trial
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To test the hypothesis:
Dietitians will be asked to use the data-recording tool on
all new clients over a 10 month period
All data will be analysed and reports prepared
The test group get their report back
The control group will not
Weight loss expected to be greater in the test group

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Concepts RCT Plan Survey Audit ChallengesProgress
DietitiansDietitians
Data
recording
tool
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
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Review of current practice
Initial tools and guidelines
Retrospective Audit
Updated tools and guidelines
Dec
2011

Cross-Sectional Survey
Participants
Dietitians providing a service for obesity (n=1000)
Anywhere in Australia
Online 15 minute anonymous survey
November 2011
n=200
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Cross-Sectional Survey
Objective is to describe:
Dietetic services for obesity
Variations in service delivery (process)
Variations in intervention (process)
Factors influencing practice (process)
Data recording and reporting practices
Compare these findings to model data-recording tool
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Retrospective Audit
Participants
Two dietitians submitting paper records of ten years of
private practice service for obesity
Each dietitian contributing about 600 complete episodes
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Retrospective Audit
Objective is to:
Determine effectiveness of dietetic services for obesity
Explore relationships between process and outcome
Describe dietitians data recording and reporting
Compare these findings to model data-recording tool
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Progress to Date
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Retrospective Audit
Dec
2011

Challenges
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Retrospective Audit
Dec
2011
Concepts RCT Plan Survey Audit ChallengesProgress
End PhD
Introduction

Challenges
Getting the right treatment to the right person at the right
time…
How to record behavioural intervention
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20
Supervisors
Previous supervisory team September 2010-2011
 Professor Helen Truby
Head of Department Nutrition and Dietetics, Monash
 Associate Professor Terrence Haines
Director, Allied Health Research Unit, Monash
 Dr Claire Palermo
Senior lecturer, Department of Nutrition and Dietetics, Monash
From November 2011
 Professor Paul Komesaroff
Director, Monash Centre for Ethics and Medicine in Society
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December 2011Measuring Dietetic Practice for Obesity (MDP-O)

Data-recording tool
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Measuring Dietetic Practice (Dec 2011)

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