Clinical Decision Support for Collaborative Diet Goal Setting in Primary Care

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Point-of-care tools that support shared decision making for collaborative diet goal setting can improve efficient, evidence-based dietary counseling in primary care.

Project Details -
Completed

Despite the need for dietary management for chronic disease prevention and management, most patients are left to navigate diet changes and seek out education and support on their own. This is especially true for patients from low-income and minority communities who bear a disproportionate burden of diet-related chronic disease and have less access to dietetics and specialist care. While self-management can yield patient success, it is difficult to maintain changes through self-management alone. The Chronic Care Model emphasizes synergy between self-management and the healthcare system for chronic care that improves patient’s chronic disease outcomes and ultimately reduces health inequity.

Despite the broad acknowledgment of its role in chronic disease, diet is addressed inconsistently and ineffectively in primary care, the setting in which most patients’ chronic disease risk is managed. While primary care providers (PCPs) are ideally positioned to promote the adoption of a healthful diet to reduce chronic disease risk, doing so effectively is challenging because PCPs have limited training in nutrition. To address this issue, researchers sought to develop a useable and feasible clinical decision support system (CDSS) that captures patient diet data and aids the PCP and patient in setting data-driven collaborative goals, an evidence-based technique for promoting health behavior change.

The specific aims of the research were as follows:

  • Develop a user-centered and clinical workflow-compatible CDSS by engaging key stakeholders in iterative feedback and testing.
  • Test the CDSS with practicing PCPs in a controlled “lab” setting and refine it based on results.
  • Deploy the CDSS in a clinic-based pilot cluster randomized trial to evaluate trial and intervention feasibility.

Researchers developed a user-centered and clinical workflow-compatible clinical decision support (CDS) tool by engaging key stakeholders in iterative feedback and then tested the CDS tool with practicing PCPs in a controlled “lab” setting, using the results to inform the final tool. The team then evaluated the CDS tool in a 3-month cluster randomized controlled trial in 10 high-volume primary care clinics of a federally qualified health center network to examine the tool’s impact on patient diet goal setting, diet goal self-efficacy, and diet quality as well as provider diet counseling, attitudes, and competence.

Researchers found that PCPs used the CDS tool in 100 percent of appointments and that diet counseling competency significantly increased among the intervention group compared to the control group, while self-efficacy trended positively. This research suggests that a user-centered CDS for collaborative diet goal setting is feasible for use in primary care and that point-of-care tools that support shared decision making, may therefore influence relevant healthcare quality outcomes, and should be tested in a future trial.