BACKGROUND Integrated health care models create opportunities for registered dietitian nutritionists (RDNs) to provide nutrition-related care and engage in multidisciplinary teams to improve clinical outcomes. While benefits of integrated care (IC) have been reported, little is known about the impact of the RDN within an IC model. OBJECTIVE Our primary objective was to identify whether IC vs traditional care (TC) increases the number of RDN patient visits. Our secondary objective was to evaluate clinical outcomes of patients seeing an RDN vs not, regardless of care model. DESIGN This was a retrospective cohort study. PARTICIPANTS/SETTING Patients were aged 3 to 94 years and from a patient-centered medical home in Boston, MA. MAIN OUTCOME MEASURES We measured 3-month total and average number of patients seen by the RDN in TC vs IC. Changes in adult hemoglobin A1c, weight, and pediatric body mass index (measured as kg/m2) among high-risk patients seen by an RDN compared to patients not seen by an RDN. STATISTICAL ANALYSIS Data were obtained from electronic medical records and analyzed utilizing Mann-Whitney U test, analysis of covariance, and paired sample t tests. RESULTS The RDN saw 145 patients (137 adult, 8 pediatric) in the TC model compared to 185 patients (135 adult, 50 pediatric) in the IC model. Mean number of patients seen per session was 3.20 in the TC model vs 4.63 in the IC model (P=0.004). Adult hemoglobin A1c within-group differences decreased by 0.42%±1.49% (P=0.007) for patients seen by an RDN and decreased 0.15%±1.47% (P=0.012) for patients not seen by an RDN. Adult weight within-group differences decreased 1.0±7.2 kg (P=0.15) for patients seen by a RDN and increased 0.1±5.6 kg (P=0.70) for patients not seen by a RDN. Pediatric BMI showed no change between or within groups. CONCLUSIONS The IC model increased 3-month total number of patients seen by an RDN. High-risk patients who saw an RDN had a significant decrease in hemoglobin A1c.

中文翻译：

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在高风险、少数族裔人群中改善与综合护理模式相关的注册营养师营养师服务的获取和影响

背景 综合医疗保健模式为注册营养师营养师 (RDN) 创造了机会，以提供与营养相关的护理并参与多学科团队以改善临床结果。虽然已经报道了综合护理 (IC) 的好处，但对 IC 模型中 RDN 的影响知之甚少。目标 我们的主要目标是确定 IC 与传统护理 (TC) 是否会增加 RDN 患者就诊次数。我们的次要目标是评估接受 RDN 与未接受 RDN 的患者的临床结果，无论护理模式如何。设计 这是一项回顾性队列研究。参与者/地点 患者年龄在 3 至 94 岁之间，来自马萨诸塞州波士顿的一个以患者为中心的医疗之家。主要结局指标我们测量了 3 个月内 RDN 在 TC 与 IC 中看到的患者总数和平均人数。与 RDN 未观察到的患者相比，RDN 观察到的高危患者的成人血红蛋白 A1c、体重和儿童体重指数（以 kg/m2 为单位）的变化。统计分析数据从电子病历中获得，并使用 Mann-Whitney U 检验、协方差分析和配对样本 t 检验进行分析。结果 RDN 在 TC 模型中看到 145 名患者（137 名成人，8 名儿童），而在 IC 模型中则有 185 名患者（135 名成人，50 名儿童）。TC 模型中每次治疗的平均患者人数为 3.20，而 IC 模型中为 4.63 (P=0.004)。RDN 所见的成人血红蛋白 A1c 组内差异降低了 0.42%±1.49% (P=0.007)，RDN 未见的患者则降低了 0.15%±1.47% (P=0.012)。成人体重组内差异减少 1.0±7.2 kg (P=0. 15) 对于 RDN 看到的患者，增加 0.1±5.6 kg (P=0.70) 对于 RDN 未看到的患者。小儿 BMI 显示组间或组内没有变化。结论 IC 模型增加了 3 个月 RDN 看到的患者总数。看到 RDN 的高危患者的血红蛋白 A1c 显着下降。