(taken from abstract) American hemodialysis patients are frequently malnourished. This contributes to dialysis patient mortality rates that are the highest in the industrialized world at 22% per year. Poor nutritional status probably also contributes to high health care costs (an average of two hospitalizations annually per patient and total Medicare expenditures of $11 billion per year) and diminished quality of life. Our prior work identified five potentially modifiable nutritional barriers (poor appetite, inadequate dialysis dose, poor nutritional knowledge, low fluid intake, and needing help shopping and cooking) and pilot tested a promising approach to overcome these barriers. This proposed community-based randomized controlled trial extends our prior work by targeting specific nutritional barriers with a tailored feedback and education intervention. Thirty dialysis facilities in northeast Ohio will be randomly assigned to intervention and control groups, with 135 malnourished patients enrolled from 15 intervention facilities and 135 from 15 control facilities. Baseline evaluation will include measures of nutritional status, specific barriers, inpatient expenditures, and quality of life. On a monthly basis for 12 months, intervention patients and their dietitians will receive tailored feedback and education on overcoming patient-specific barriers. They will then meet monthly to jointly formulate a care plan addressing these barriers. Control patients will continue to get usual care. Major analyses will compare changes in nutritional parameters, hospitalization-related costs, and quality of life in intervention vs. control patients with adjustment for nesting of patients within facilities. The proposed project will test a novel intervention that targets patients and providers as they together make nutrition-related decisions. Overcoming specific barriers may lead not only to improved nutritional status but also to better patient survival, decreased health care costs, and increased quality of life.
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