Top Things to Know: Rapid Diet Assessment Screening Tools for CVD Risk Reduction Across Healthcare Settings
Published: August 07, 2020
Prepared by Radhika Rajgopal Singh, PhD, Vice President, Science, Medicine and Health
- Poor dietary quality has surpassed all other mortality risk factors, accounting for 11 million deaths and approximately 50% of cardiovascular disease (CVD) deaths globally.
- Despite evidence supporting the value of diet assessment, education, and counseling by clinicians and other members of a healthcare team, data have shown sizable gaps in the percentage of patients who report receiving healthcare provider-delivered dietary counseling.
- Disparities were found in diet counseling related to access to healthcare, with men and the uninsured significantly less likely to receive diet assessment. While diet quality was positively correlated with socioeconomic indicators, low nutrition knowledge was associated with low diet quality, regardless of education and income.
- Several factors can make population-wide dietary assessment and counseling more feasible for healthcare providers. These include the expanded reach of health systems, providers being seen as trusted sources of advice and greater use of the Electronic Health Record (EHR), which provides Clinical Decision Support (CDS) documentation, facilitates referral processes, and eases diet assessment integration into existing workflows with less clinical burden than existed previously.
- Of the 15 tools reviewed for this statement, three (the Mediterranean Diet Adherence Screener and its variations, the modified, shortened Rapid Eating Assessment for Participants, and the modified version of the Starting the Conversation tool ) met the greatest number of the proposed theoretical and practice-based validity criteria, including being brief and easily applicable across several race and socioeconomic populations.
- The EHR is the ideal platform to prompt clinicians and other healthcare providers to capture dietary data and deliver dietary advice to patients. It provides for secure storage of data and enables access to data when needed at the point-of-care.
- The statement describes the technology challenges with EHR and supportive approaches for seamless implementation and scalability of tools across institutions, including prototype testing by end users.
- The process of integrating rapid diet screener tools into a health system can be complex initially but integration is a critical facet of improving primary prevention that ultimately involves concomitant consideration of the structural barriers (i.e., time, reimbursement) that impede clinical care.
- In an era in which medical nutrition education and training are limited and sometimes inadequate, diet screener tools with clinical nutrition support and guidance on when to refer to another healthcare provider, can bridge gaps in knowledge and implementation.
- Future opportunities include ensuring the validity of modified diet screener tools to conform to current dietary guidance, particularly in diverse populations, promoting behavioral change and exploring the use of machine learning to develop and validate diet screener tools.
Citation
Vadiveloo M, Lichtenstein AH, Anderson C, Aspry K, Foraker R, Griggs S, Hayman LL, Johnston E, Stone NJ, Thorndike AN; on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Stroke Council. Rapid diet assessment screening tools for cardiovascular disease risk reduction across healthcare settings: a scientific statement from the American Heart Association [published online ahead of print August 7, 2020]. Circ Cardiovasc Qual Outcomes. doi: 10.1161/HCQ.0000000000000094.