Issue 22:1 of Topics in Clinical Nutrition takes on the subject of "Changes in Clinical Dietetics and Nutrition Management" and thanks to our guest editor, Professor Julie O'Sullivan Maillet, for her dedication in putting this issue together. Her comments follow:
Clinical dietetics is consistently evolving. Thirty years ago nutrition assessment was a new concept. Many RDs did menu selection with patients and recommending diet orders was a limited role, let alone, writing diet orders. Private practice and insurance and government reimbursement were minimal to nil. Technology was using a calculator and punch cards for statistics. Planning and evaluation were important but doing these processes in clinical dietetics then was a rare thought. Today, clinical dietetics is a competitive field emphasizing its unique value, planning for its future, thinking through how to empower dietitians, designing staffing patterns to meet the needs of the institution, obtaining diet writing privileges, tackling reimbursement in healthcare and private practice, and looking at patient satisfaction and outcomes differently. This issue of Topics in Clinical Nutrition describes the perceptions of the authors as we move into the latter part of the first decade of the 21st century. After reviewing the issue, my hope is that you think about dietetics differently and that the authors have impacted your practice decisions.
More about this issue. Evaluation is essential in all areas of practice. Much is being written on evidence-based practice and measuring outcomes. The McClusky article reminds us to be patient centered and that patient satisfaction must be part of our evaluation as a member of a large team focusing on the patient.
The empowerment research by Buckley et al provides a validated tool to examine how work conditions influence the RDs' access to opportunities, support, and resources in acute care. Empowerment increased with duration of employment, age, and education. Empowered individuals often work more effectively, competently, and as leaders. Increasing empowerment from moderate to high might improve dietitian and patient satisfaction.
The Hess article reviews the history of dietetics and ties it to our future and our movement into levels of practice: entry, specialty, and advanced. All 3 levels are needed in different amounts based on the facility. The staffing pattern answer is not easy and will vary. In addition, the article gives ideas to shape our future.
Moving to technology, Charney describes the electronic healthcare record and informatics and how it is changing dietetics. It talks about standardized language evidence-based practice and how to search and use such information today. The use of technology to improve and describe the care we provide will advance the dietetics practice.
The Hager article provides a comprehensive overview of the healthcare regulatory issues that impact diet order writing at the state and federal level. Numerous examples of how different states address the issue should provide you ideas of how to move toward writing diet orders and finally provide guidelines in implementing dietorder protocols in your institutions.
The article about managing clinical nutrition in this issue is the process of strategic planning. Isaacs-Jordan explains the relationship of dietetic planning to the organizational plan and then provides real-life examples of how to use an organization's mission, visions, and plans and incorporate them into dietetic plans to reshape dietetic practice and improve services.
Moving on to medical nutrition therapy (MNT), there are 2 articles, one the update of MNT and then more specifically MNT in private practice. The Hodorowicz article provides a step-by-step review of how to become a provider, a process that can be overwhelming. The article gives detailed information important for new and existing providers as the government moves to NPI from PIN (National Provider Identification from Provider Identification Number). Hodorowicz also provides a guide to quality documentation of services. After discussing traditional MNT and Medicare, Hodorowicz describes other Medicare venues that impact MNT, such as Medicare Health Support Programs and the Initial Preventive Physical Exam.
The Gershner article takes the reader on a journey of the trials and rewards of running a private practice. The article takes you through the decision on setting up the practice, how to become credentialed to receive insurance reimbursement, and finally actually receiving the payment. The article is a practical guide for anyone considering or running a private practice.
As clinicians, our jobs are to help patients or clients consume the food and nutrients they need, document our successes or failures in accomplishing that, and then evaluate the outcomes and plan to improve the outcomes in the future. Hopefully, these articles help you think through some of the ways to enhance your practice.
In addition to the clinical dietetic management articles, Miller and colleagues address the issue of carbohydrate-restricted diets for central obesity, a feature of metabolic syndrome. They found that a reduced-carbohydrate diet can be effective in promoting weight loss and improving body composition and blood pressure in a sample of patients in an outpatient clinic.
Thanks to everyone for their contributions to this issue and best wishes for a successful and totally healthy New Year!!
Judith A. Gilbride, PhD, RD, FADA, Editor
Julie O'Sullivan Maillet, PhD, RD, FADA, Guest Editor