Disease management programs are key to controlling costs and improving outcomes for patients with chronic heart failure with nutrition is an essential component of these programs. Despite the availability of evidence-based nutrition practice guidelines for heart failure, a majority of Registered Dietitians are unaware of or unfamiliar with these guidelines. The ubiquity of smart phones and other on-hand, on-demand devices makes it possible to provide information from guidelines with a level of convenience that was not possible even a few years ago. The Academy of Nutrition and Dietetics proposes to leverage the advances in mobile technology to develop mobile applications to deliver guidelines, patient education, and related tools to Registered Dietitians, family practice physicians, and patients with heart failure as a first step toward redeployment of all the Academy's evidence-based nutrition practice guidelines and toolkits. The Academy proposes to develop and evaluate the use of mobile apps, podcasts, and other on-hand, on- demand approaches to promote the adoption of guidelines by nutritionists and dietitians and to prompt patients to seek appropriate counseling and adopt evidence-based nutritional behaviors for the treatment of chronic heart failure. Identification of the most effective approaches will likely improve patient outcomes and reduce burdens of care for patients, providers, and payers. Lessons learned through this project may be readily adapted to the Academy's other practice guidelines to improve both provider and patient adherence and outcomes for other needs. To achieve these goals, the Academy proposes the following specific aims:
Specific Aim 1. To develop and refine software applications and social media tools to deliver heart failure nutrition practice guidelines and related tools to Registered Dietitians, patients, and primary care providers through web-enabled smartphones and other mobile devices.
Specific Aim 2. To evaluate the efficacy of the new mobile dissemination tools for improving the adoption and use of heart failure nutrition practice guidelines by examining provider-level changes, system-level changes, and changes in patient outcomes through a randomized controlled trial of the tools in patient centered medical home settings that serve patients with heart failure and that include a Registered Dietitian on staff. The Academy will evaluate the tools in a randomized controlled trial of six patient centered medical homes that care for patients with heart failure and that have a Registered Dietitian on staff but do not currently routinely refer patients with heart failure to a dietitian. Specific deliverables and outcomes include a suite of mobile applications for delivering evidence-based nutrition practice guidelines, referral decision tools, patient education and self-management tools, and other tools as well as evidence or preliminary evidence of the efficacy of these tools for changing provider practice, system practice, and patient care/perceptions/outcomes.
Heart failure affects as many as 5.8 million patients in the United States, with health care costs estimated to exceed $39 billion annually. Even though nutrition is a key component of care in evidence based guidelines and there is low compliance with those recommendations (27-88%), most insurers do not pay for and many patients with heart failure do not receive care from the nutrition experts, registered dietitians. This project wll test different new ways of communicating with physicians, dietitians and patients (e.g. mobile phone apps, video, or podcasts) to increase awareness and use of the guidelines and therefore improve care for persons with heart failure.