AUTHOR=Lamers-Johnson Erin , Kelley Kathryn , Knippen Kerri Lynn , Feddersen Kimberly , Sánchez Damien M. , Parrott J. Scott , Colin Casey , Papoutsakis Constantina , Jimenez Elizabeth Yakes 

TITLE=A quasi-experimental study provides evidence that registered dietitian nutritionist care is aligned with the Academy of Nutrition and Dietetics evidence-based nutrition practice guidelines for type 1 and 2 diabetes

JOURNAL=Frontiers in Nutrition

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.969360

DOI=10.3389/fnut.2022.969360

ISSN=2296-861X

ABSTRACT=Background:  One previous study examined implementation of evidence-based nutrition practice guidelines (EBNPG). 
Objectives: To describe alignment of registered dietitian nutritionists' (RDNs) documented nutrition care with the Academy of Nutrition and Dietetics’ EBNPG for diabetes and examine impact of a midpoint training on alignment with the guideline. 
Methods: In this two-year, quasi-experimental study, nineteen RDNs providing outpatient medical nutrition therapy to adults with diabetes (n=562) documented 787 encounters. At study midpoint, RDNs received a guideline content training. A validated, automated tool was used to match standardized nutrition care process terminology (NCPT) in the documentation to NCPT expected to represent guideline implementation. A congruence score ranging from 0 (recommendation not identified) to 4 (recommendation fully implemented) was generated based on matching. Multilevel linear regression was used to examine pre-to-post training changes in congruence scores. 
Results: Most patients (~75%) had only one documented RDN encounter. At least one guideline recommendation was fully implemented in 67% of encounters. The recommendations “individualize macronutrient composition” and “education on glucose monitoring” (partially or fully implemented in 85% and 79% of encounters, respectively) were most frequently implemented. The mean encounter congruence scores were not different from pre-to-post guideline training (n=19 RDNs, 519 encounters pre-training; n=14 RDNs, 204 encounters post-training; β=-0.06, SE=0.04; 95% CI: -0.14, 0.03).  
Conclusions: Most RDN encounters had documented evidence that at least one recommendation from the EBNPG was implemented. The most frequently implemented recommendations were related to improving glycemic control. A midpoint guideline training had no impact on alignment of care with the guideline.