Of Professional InterestNutrition Care Process and Model: ADA adopts road map to quality care and outcomes management☆,☆☆
Section snippets
Background
Prior to the adoption of this standardized Nutrition Care Process, a variety of nutrition care processes were utilized by practitioners and taught by dietetics educators. Other allied health professionals, including nursing, physical therapy, and occupational therapy, utilize defined care processes specific to their profession (4, 5, 6). When asked whether ADA should develop a standardized Nutrition Care Process, dietetics professionals were overwhelmingly in favor and strongly supportive of
Definition of quality/rationale for a standardized process
The National Academy of Science's (NAS) Institute of Medicine (IOM) has defined quality as “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (7, 8). The quality performance of providers can be assessed by measuring the following: (a) their patients' outcomes (end-results) or (b) the degree to which providers adhere to an accepted care process (7, 8). The Committee on
Definition OF ADA's NCP
Using the terms and concepts described above, ADA's Nutrition Care Process is defined as “a systematic problem-solving method that dietetics professionals use to critically think and make decisions to address nutrition related problems and provide safe and effective quality nutrition care.”
The Nutrition Care Process consists of four distinct, but interrelated and connected steps: (a) Nutrition Assessment, (b) Nutrition Diagnosis, (c) Nutrition Intervention, and d) Nutrition Monitoring and
Purpose of NCP
ADA's Nutrition Care Process, as described in Figure 2, gives dietetics professionals a consistent and systematic structure and method by which to think critically and make decisions. It also assists dietetics professionals to scientifically and holistically manage nutrition care, thus helping patients better meet their health and nutrition goals. As dietetics professionals consistently use the Nutrition Care Process, one should expect a higher probability of producing good outcomes. The
Distinction between MNT and the NCP
Medical Nutrition Therapy (MNT) was first defined by ADA in the mid-1990s to promote the benefits of managing or treating a disease with nutrition. Its components included an assessment of nutritional status of patients and the provision of either diet modification, counseling, or specialized nutrition therapies. MNT soon became a widely used term to describe a wide variety of nutrition care services provided by dietetics professionals. Since MNT was first introduced, dietetics professionals
Nutrition Care Model
The Nutrition Care Model is a visual representation that reflects key concepts of each step of the Nutrition Care Process and illustrates the greater context within which the Nutrition Care Process is conducted. The model also identifies other factors that influence and impact on the quality of nutrition care provided. Refer to Figure 1 for an illustration of the model as described below:
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Central Core: Relationship between patient/client/group and dietetics professional;
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Nutrition Care Process:
Impact on coverage for services
Quality-related issues are gaining in importance worldwide. Even though our knowledge base is increasing, the scientific evidence for most clinical practices in all of medicine is modest. So much of what is done in health care does not maximize quality or minimize cost (44). A standardized Nutrition Care Process is a necessary foundation tool for gathering valid and reliable data on how quality nutrition care provided by qualified dietetics professionals improves the overall quality of health
Summary
Just as maps are reissued when new roads are built and rivers change course, this Nutrition Care Process and Model reflects recent changes in the nutrition and health care environment. It provides dietetics professionals with the updated “road map” to follow the best path for high-quality patient/client/group-centered nutrition care.
Acknowledgements
The Quality Management Committee Work Group developed the Nutrition Care Process and Model with input from the House of Delegates dialog (October 2002 HOD meeting, in Philadelphia, PA). The work group members are the following: Karen Lacey, MS, RD, Chair; Elvira Johnson, MS, RD; Kessey Kieselhorst, MPA, RD; Mary Jane Oakland, PhD, RD, FADA; Carlene Russell, RD, FADA; Patricia Splett, PhD, RD, FADA; Suzanne Bertocchi, DTR, and Tamara Otterstein, DTR; Ellen Pritchett, RD; Esther Myers, PhD, RD,
References (55)
Is nutritional diagnosis a critical step in the nutrition care process?
J Am Diet Assoc
(2002)- et al.
A proposed model for effective nutrition care
J Am Diet Assoc
(2001) - et al.
A problem-based nutrition care model that is diagnostic driven and allows for monitoring and managing outcomes
J Am Diet Assoc
(2002) - et al.
Nutrition clinic: An integrated component of an undergraduate curriculum
J Am Diet Assoc
(1985) - et al.
A model for making outcomes research standard practice in clinical dietetics
J Am Diet Assoc
(1998) Expanding medical nutrition therapy: An argument for evidence-based practices
J Am Diet Assoc
(2003)The professional development portfolio process: Setting goals for credentialing
J Am Diet Assoc
(2002)- et al.
Evidence-based practice guides vs. protocols: What's the difference?
J Am Diet Assoc
(2001) - et al.
Research and the dietetics profession: Making a bigger impact
J Am Diet Assoc
(2003) American Dietetic Association Strategic Plan
Understanding Variation: The Key to Managing Chaos
Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment No. 43 (Prepared by the University of California at San Francisco-Stanford Evidence-based Practice Center under Contract No. 290-97-0013)
Basic Nursing Theory and Practice
Guide to Physical Therapist Practice
The Guide to Occupational Therapy Practice
Am J Occup Ther
Crossing the Quality Chasm: A New Health System for the 21st Century Committee on Quality in Health Care in America. Rona Briere, ed
Developing and Validating Evidence-Based Guides for Practice: A Tool Kit for Dietetics Professionals
Community Nutrition. Challenges and Opportunities
Planning, Implementation and Evaluation of Nutrition Programs
A framework for the continual improvement of health care: Building and applying professional and improvement knowledge to test changes in daily work
Jt Comm J Qual Improv
CADE Accreditation Handbook
Nursing process overview. Applying Nursing Process. Promoting Collaborative Care
Nutrition Assessment Support and Management
What is a diagnosis?
JAMA
Application of Nursing Process and Nursing Diagnosis: An Interactive Text for Diagnostic Reasoning
Cited by (323)
Behavioral Approaches to Nutrition Counseling in the Primary Care Setting
2022, Medical Clinics of North AmericaAnalyzing Dietary Behaviors Self-reported by People With Diabetes Using a Behavior Change Technique Taxonomy
2022, Journal of Nutrition Education and Behavior
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If you have questions regarding the Nutrition Care Process and Model, please contact Ellen Pritchett, RD, CPHQ, Director of Quality and Outcomes at ADA, [email protected]
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0002-8223/03/10308-0014$35.00/0