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Hand dissertation 6.12.18.pdf (2.37 MB)

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The Impact of Patient to Registered Dietitian Nutritionist Ratios on Dialysis Nutrition Outcomes

Hand, Rosa K
http://orcid.org/0000-0003-1314-1964
http://rave.ohiolink.edu/etdc/view?acc_num=case1529406986089747

Abstract Details

2018, Doctor of Philosophy, Case Western Reserve University, Clinical Research.
Dialysis is the major treatment for End Stage Renal Disease in the United States. Despite major quality improvement initiatives by the Centers for Medicare and Medicaid Services (CMS), dialysis costs remain high and patient outcomes are poor, especially in comparison to other countries. In particular, there is wide variation in patient outcomes between facilities, even when adjusting for patient case mix. Differences in patient to staff ratios at dialysis facilities has been suggested as a possible explanation for this variation but has not been tested. Because of the critical role of nutrition in maintaining patients’ health while on dialysis, the role of the renal registered dietitian nutritionist (RDN) is of particular interest. We used facility-level data from CMS and structural equation modeling to assess the relationship between patient: full time equivalent (FTE) staff ratios for RDNs, nurses, dialysis technicians and social workers with the outcomes of standardized hospitalization rate, standardized mortality ratio, and did not find staffing ratios to be an important explanatory variable. However, these ratios are limited by the ecological fallacy and their limited specificity including the lack of qualitative information on what occurs during available staff time. Therefore, we also used direct observation of 14 RDNs in Northeast Ohio to quantify and describe RDN roles and the proportion of time they consume. We found that direct care consumed an average of 24.9±11.5% of RDNs’ time, followed by professional communication at 20.9±6.7%. The average time for per patient interaction was 6:57±4:03 (m:ss). Patient: FTE RDN ratios were not correlated with time in direct care (r=0.02). Together these results demonstrate the difficulty in mandating staffing ratios or responsibilities that will result in improved patient outcomes.
James Spilsbury, PhD (Committee Chair)
Ashwini Sehgal, MD (Advisor)
Jeffrey Albert, PhD (Committee Member)
Hope Barkoukis, PhD, RDN, LD (Committee Member)
175 p.
Health Care Management; Nutrition
dialysis staffing; dietitian staffing; renal dietitian; dialysis nutrition outcomes; direct observation of health professionals

Recommended Citations

Citations

  • Hand, R. K. (2018). The Impact of Patient to Registered Dietitian Nutritionist Ratios on Dialysis Nutrition Outcomes [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1529406986089747

    APA Style (7th edition)

  • Hand, Rosa. The Impact of Patient to Registered Dietitian Nutritionist Ratios on Dialysis Nutrition Outcomes. 2018. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1529406986089747.

    MLA Style (8th edition)

  • Hand, Rosa. "The Impact of Patient to Registered Dietitian Nutritionist Ratios on Dialysis Nutrition Outcomes." Doctoral dissertation, Case Western Reserve University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=case1529406986089747

    Chicago Manual of Style (17th edition)

case1529406986089747
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© 2018, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.