Latest Trends, Research in Dietetics Clinical Process Improvement
This podcast series aims to highlight the science, psychology, and strategies behind the practice of dietetics. Moderator, Lisa Jones, MA, RDN, LDN, FAND, interviews prominent dietitians and health professionals to help our community think differently about food and nutrition.
In this episode, Lisa Jones interviews Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, about quality trends and research in nutrition and dietetics, including the recognition and identification of malnutrition in adults and pediatrics, the adoption of formal quality improvement methodologies, and evidence-based resources for clinicians. This is episode 1 of a 4-part series.
Additional Resources:
Academy of Nutrition and Dietetics. Accessed July 19, 2023. https://www.eatright.org/
Commission on Dietetic Registration. Accessed July 19, 2023. https://www.cdrnet.org/
Listen to episode 2 of this 4-part podcast series here.
Lisa Jones, MA, RDN, LDN, FAND, is a registered dietitian nutritionist, speaker, and author (Philadelphia, PA).
Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at the University of Pittsburgh Medical Center (UPMC) Presbyterian Shadyside working in the Department of Quality Improvement (Pittsburgh, PA), a member of the Academy of Nutrition and Dietetics Board of Directors, Director of the Academy’s House of Delegates, and a member of the House Leadership Team.
TRANSCRIPTION:
Speaker 1:
Hello and welcome to Nutrition411: The Podcast. A special podcast series led by registered dietician and nutritionist, Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant 360.
Lisa Jones:
Hello and welcome to Nutrition411: The Podcast. Where we communicate the information that you need to know now about the science, psychology, and strategies behind the practice of dietetics. Today's podcast is part of a series of short episodes on clinical process improvement, featuring a Q&A with Sherri Jones. I want the opportunity to introduce Sherri. First of all, Sherri, thank you for being here.
Sherri Jones:
You're welcome.
Lisa Jones:
Yeah, we're excited to have you today. Sherri Jones has been a registered dietician nutritionist for 35 years and is currently the Quality Manager at the University of Pittsburgh Medical Center Presbyterian, Shadyside, working in the Department of Quality Improvement. In this role, she manages seven full-time quality improvement specialists who are responsible for value-based care measures and quality scorecard outcomes. Sherri has worked in the field of quality improvement since 2012 and achieved her Six Sigma Green Belt in 2015. She's also a certified professional in healthcare quality national certification in 2020. And you can read Sherri's full bio on our website.
So again, welcome Sherri. We are excited for you to be here, and we are going to dive right in with our first episode on uncovering the latest research and trends in dietetics. Our topic today is uncovering the latest research. So, Sherri, I want to ask you, as dietitians, we always strive to provide the best possible care to our patients. With that in mind, how can the principles of clinical process improvement be applied in dietetics to then enhance the effectiveness and efficiency of our practice?
Sherri Jones:
Great question, Lisa. And I also want to thank you for having me today for this podcast. As you can see from my bio, I have a dual passion for dietetics and nutrition as well as quality and process improvement and have been in the quality and process improvement arena for the past many years. I can say that quality and process improvement can be applied in any aspect of dietetics and nutrition, no matter the practice segment. Whether it be clinical, food service, public health, or education, quality is an important aspect of truly any industry and performance indicator. Even if you look at our own professional development portfolio for dietitian registration and having to get ongoing CPEUs, we need to continue to improve our general knowledge base and performance. So quality and process improvement is important no matter what we do as dietetics professionals.
And I'd like to add on to that that many healthcare regulations and accreditation programs also have a quality element. And in some aspects, particularly with clinical and acute or long-term care, there are requirements for what is known as QAPI, Quality Assurance And Performance Improvement. Really, in the healthcare arena, dating back to 2001, the Institute of Medicine, now called the Academy of Medicine, came out with their second report called Crossing the Quality Chasm, where they identified the six aims of quality in healthcare. And those six aims were indeed to help reform the healthcare arena. And those include providing care that's safe, effective, patient-centered, timely, efficient, and equitable. So you can see that even in the Academy of Medicine's six aims, effectiveness, and efficiency are two of those six aims as it relates to quality and process improvement. So I guess to my point, and to circle back to your question, the principles of process improvement are so vitally important to dietetics and healthcare professionals these days.
Lisa Jones:
Yes, that's so true. And it's fantastic what you were saying earlier about that it doesn't matter what aspect you're working in, no matter what your practice is either, that you can still apply this. Because I'll date myself back to when I was in college, I don't really remember, and correct me if I'm wrong here, Sherri, I don't really remember, are any of our classes talking about the importance of quality improvement process? And it should have been something, and I know now it's probably instituted in the curriculum, but back then it wasn't as much. And it's such a vital part because you're talking about the effectiveness and the efficiency. And I am curious a little bit to know about the latest research, insights, and trends in this area that we should be aware of, especially for someone like myself who doesn't remember from back in the day learning about it.
Sherri Jones:
Right. Well, I know the ACEND Standards have since changed. I am even older than you, Lisa. So they do now incorporate a lot more as it relates to research and quality and process improvement, leadership business skills. So it really is making dietetics professionals more well-rounded. And as far as trends, research, insights, and trends, let me just first start with trends. I can say that the Academy of Nutrition and Dietetics for many years has had a quality management committee. There are several committees that fall under the academy, and quality management has been a longstanding committee. Knowing that quality trends have been ever evolving, not just in healthcare in general, but also in our nutrition and dietetics profession. And amongst the quality management committee and everything that they do, there have been ongoing trends. Having served on the Quality Management Committee for three years, and then my fourth year as the chair, there were many, many things that we were working on.
I would have to say that one of the main trends with regard to quality and process improvement has by far been the recognition and identification of malnutrition. It started out with the adult population and then moved into the pediatric population. And a lot has occurred With all of that. There are malnutrition recognition criteria that came out with both adults and pediatrics. And then several years ago, the academy partnered with Avalara Health to come up with what is called MQII, the Malnutrition Quality Improvement Initiative. And there is a plethora of information available about the MQII initiative. And subsequently stemming from that, just in the past year or so, was the Global Malnutrition Composite score through CMS, in which healthcare facilities can follow specific quality improvement DRG criteria for malnutrition. That has been a huge improvement for our profession and having that composite score being recognized by CMS.
And then what really kind of backs up and supports all of that with an additional trend in adding that evidence-based practice piece is a nutrition-focused physical exam. That's a big component of appropriately evaluating and identifying malnutrition. Also, another trend that I've seen in general in healthcare, not specific to the nutrition in dietetics arena, but healthcare in general, is the adoption of formal quality improvement methodologies. Many institutions and healthcare facilities have adopted methodologies such as Toyota Lean or Six Sigma. There's also a formal methodology called Team Steps, something that the Institute for Healthcare Improvement, their general improvement methodology is called the Deming Model or the PDSA model of Plan, Do, Study, and Act. And I know personally my institution, the University of Pittsburgh Medical Center, Presbyterian Shadyside, it's a regulatory requirement that we have to have a performance improvement document that regulates and moves our hospital toward a strong culture of quality and performance improvement.
And we do say in that document that the PDSA model is our UPMC model for performance improvement. But I have heard of, in talking with other clinical nutrition managers across the country, since I'm a member of the CNM Dietetic Practice Group, I do hear a lot of facilities that are having all of their staff learn about Toyota Lean or Lean Six Sigma and those types of things. So dietitians are really starting to learn and adopt a lot of those more formal quality and process improvement methodologies. So those are the trends that I'm seeing. As far as research insights, I would say that the best place to go to learn about what's new in research is to access the academy's evidence and analysis library. There is a plethora of different topics on there with regard to what are the best practice standards, what are the evidence-based nutrition practice guidelines, to ensure that dietician professionals are delivering the best practices, and the gold standard in evidence support.
And then as well, with that whole nutrition lens, if anyone is interested, the academy also has something that's called the Nutrition Research Network, and you can look that up as well on the academy website. It's a group of dietitians that will help to conduct and support practice-based research at their local level. So it's kind of a partnership between the academy and then your local facility where you work, that you can help to implement nutrition-based research and support what's currently happening or recommend to the academy, certain nutrition-based research that should be done. And then members of that nutrition research network can get involved in that specific research to help support that. And we all know, having nutrition-based research out there in the literature is what our profession really needs to do to elevate us and to elevate our practice just like the other physician providers, and other allied health professionals. So nutrition research is a really important aspect, and I'm glad you asked that question, Lisa, with regard to research insights and trends. Because it's so very important to our profession.
Lisa Jones:
Yes. I couldn't agree more, Sherri. And wow, as I was listening to you say all that stuff, or giving all those resources I was kind of thinking you need a full-time job just to keep up with everything, with all the resources.
Sherri Jones:
Oh, definitely. I know it's almost like you need to visit the academy and CDR's websites on a monthly basis because things are ever-evolving and just keeping up on everything.
Lisa Jones:
But then you're thinking like, what are the implications to having all these great resources? And then the question is, how can we then leverage these findings to then optimize patient outcomes and better serve our communities? With all those resources, you can do such great work. Do you mind sharing a little bit about that?
Sherri Jones:
Sure. So my thoughts there, to that question, in order to optimize outcomes and serve our communities, we should always want to support evidence-based practice and what the best practice standards are. I would say that in general, nutrition and dietetics practitioners are really obligated to be aware of what the current trends are, as well as the resources that are being supported and promoted by our professional organization. As well as the other regulatory bodies that are out there that we must comply with based on the practice setting that we work in.
So I would strongly recommend, to a point that we made already, Lisa, to visit the academy as well as this CDR website for more information and to keep up on everything, and to know where those resources are located. You do not need to reinvent the wheel. I was surprised when I went onto the website recently to do a little bit of preparation for these episodes to see what's out there.
And there are so many resources that are available to us as dietetics practitioners, that the Academy of Nutrition and Dietetics has done a great job in producing. So that's one. And then being aware of what is happening within your own organization facility with regard to quality and process improvement, I'm always a strong proponent for being at the table. Things are going to occur, and as I mentioned with the Institute of Medicine and everything that's happening in the healthcare arena in general, and it's not just clinical. There are things that relate to food service regulations, community. There's a big trend toward healthcare disparities in public health and identifying patients or customers that don't have access to food or even safe water and those types of things. So knowing in your practice setting, what are those quality and process improvement initiatives that are currently occurring or are going to occur in the future, and being at the table when those types of things are being discussed?
And to the third point is also how can we leverage these findings. I think of our students and interns. They're learning the latest and greatest with regard to all of this. As you heard in my bio, I've been a registered dietician nutritionist for 35 years. Hard to believe it's been that long. But as a current practitioner, I want to be up on what the latest thing is. I want to support the students and interns that are out there, whether I'm a preceptor or managing preceptors. So that we're supporting the latest trends and what students are learning, and that we can give them those practice experiences that are up on the current trends and hot topics.
Lisa Jones:
Yes, and I appreciate you sharing all those cutting-edge developments and resources with us in terms of clinical process improvement in dietetics, and then of course, talking about the implications for our field because it's so important. And we can put the links in the show notes as well. And I appreciate all your wisdom on this episode. Thank you, Sherri.
Sherri Jones:
You're quite welcome. Thanks, Lisa.
Speaker 1:
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