- Email: [email protected]
Food safety risk assessment of child nutrition programs: a survey of purchasing and food preparation practices
MONDAY, OCTOBER 4
POSTER SESSION: PROFESSIONAL SKILLS/EDUCATION/MANAGEMENT/FOOD SERVICE/CULINARY TITLE: COMPARING ATTENDANCE RATE, REFERRAL TURN AROUND TIME, and PATIENT SATISFACTION IN AN OUTPATIENT NUTRITION CLINIC MODEL USING SEVERAL SATELLITE CLINIC SITES VERSUS A MODEL USING ONE CLINIC SITE AUTHOR(S): C.F. Agamao, MS; C.B. Hollenbeck, PhD; E. Guysako, MS, RD; L. McProud, PhD, RD; San Jose State University, San Jose and Santa Clara Valley Medical Center, Santa Clara, California LEARNING OUTCOME: Participants will be able to describe the effective-ness of a multi-clinic vs single clinic model in reducing clinic noshow rate and improving patient satisfaction. TEXT: Statistics for Santa Clara County Health and Hospital System show that an average of 51% of patients failed to attend their scheduled outpatient nutrition appointment. After evaluating the existing clinic model, centralization of services and a lengthy referral process was thought to contribute to the high no show rate. To improve attendance a new clinic design was implemented in which 4 satellite clinics were established within the county. The purpose of this study was to evaluate the new process by comparing the attendance rate, referral turn around time and patient satisfaction to the previous model. The 1,149 outpatients and referrals made between May and September 2002 were analyzed to determine attendance, and referral turn around time. A telephone survey was conducted to determine patient satisfaction. Results showed that the overall attendance and no show rate among return patients improved in only 1 of the 4 clinics. The no show rate among new patients was similar in all 4 clinics and did not improve with the new model. The patient survey showed that overall patients were very satisfied with the nutrition clinic service, but rated referral turn around time as somewhat satisfied. The average no show rate for other health clinics is similar to the nutrition center. Administrators should consider focusing their efforts on improving referral turn around time to improve overall clinic attendance. Strategies to improve turn around time would include increasing dietitian staff, increasing dietitian hours, and implementing classes or group sessions versus one on one counseling. FUNDING DISCLOSURE:
TITLE: IMPROVED REIMBURSEMENT AND COMMUNICATION WITH A MEDICAL MODEL “RD CHARTING TOOL” AUTHOR(S): J.A. Krenkel, MS, RD, CNSD; G. Loredo, RD, CDE; S.T. St Jeor, PhD, RD; Division of Medical Nutrition, Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV
TITLE: SUPPER MEAL IMPROVES DIETS OF CHILDREN AT NUTRITIONAL RISK AUTHOR(S): M.L.K. Plante, RD, K.S. Bruening, PhD, RD; Syracuse University, Department of Nutrition and Hospitality Management, Syracuse, NY LEARNING OUTCOME: To describe the effect of participation in a supper meal program served at an after-school child care program on food and nutrient intake. TEXT: In some states, after-school care programs serving children in low income communities are eligible for federal reimbursement for a supper meal. The purpose of this pilot study was to assess the effect of participation in the supper meal by comparing children’s food and nutrient intake on days when they participated with days when they did not. Subjects were 13 children aged 7-12 years. Dietary intake was assessed on five consecutive days using the multiple-pass 24-hour recall technique. Diet data were analyzed for macronutrients, 4 vitamins, 2 minerals, and for number of servings of Food Guide Pyramid food groups. Differences were assessed using t-tests. The 13 children (77% male) provided 58 child*days of data. On 22 of the 58 days, children ate the supper meal. When the children ate the supper meal, the number of servings of vegetables (2.7⫾1.5 vs. 1.6⫾1.5, p⫽.0087), fruits (2.3⫾1.7 vs. 1.4⫾1.4, p⫽0.0356), and milk (4.0⫾1.5 vs. 2.4⫾1.4, p⫽.0001) were greater than on days when they did not. Intakes of vitamin A (1552⫾881 vs. 730⫾419, p⬍.0001), folate (419⫾193 vs. 304⫾217 ug, p⫽.0452), and calcium (1444⫾470 vs 970⫾457 mg, p⫽.0004) were higher on days when children ate the supper meal at the after-school program. Data from the pilot study suggest that participating in the supper meal significantly diets of school-aged children. FUNDING DISCLOSURE: This project was supported by a grant from the Faculty Development Fund, College for Human Services and Health Professions, Syracuse University.
TITLE: FOOD SAFETY RISK ASSESSMENT OF CHILD NUTRITION PROGRAMS: A SURVEY OF PURCHASING AND FOOD PREPARATION PRACTICES AUTHOR(S): J. Kwon, PhD, RD, LD; Texas Woman’s University, Denton, TX
LEARNING OUTCOME: To stimulate professional evaluation of increased reimbursement and enhanced communication by using an “RD Charting Tool” based on the medical model in the outpatient clinic setting.
LEARNING OUTCOME: To increase awareness of purchasing and food preparation practices of child nutrition programs and to identify food safety training needs for child nutrition program personnel.
TEXT: Improved healthcare collaborations are needed by our healthcare system. The National Institute of Medicine recently recommended the development of an interdisciplinary effort focused on developing a common language to improve communications. The written communication in the patient’s medical chart promotes understanding of patient needs and treatment but deficiencies have been identified in the present system of charting used by dietitians in the outpatient clinic setting. Poor communication between physicians and dietitians has potential negative consequences for patient outcomes, the future of interdisciplinary and collaborative care, and reimbursement for dietitian services. We developed and tested an “RD Charting Tool” and assessment procedures based on the medical model to improve private insurance reimbursement for MNT services utilizing an MD/RD team. We contacted private insurance companies to discuss MNT reimbursement for services and found that our team approach was usually well-accepted (⬃80-90%) when MNT codes or wellness benefits were not available. The national physician standards, mandated by the American Medical Association (AMA) and Medicare, for “levels of care” and “complexity of medical decision making” patient charting in the clinical outpatient setting were revised recently and are routinely audited for compliance. Transforming charting by the RD to utilize the medical model contributed to the development of a common language, improvements in communication between physicians and dietitians, and reimbursement of dietitian services for private insurers without MNT code, wellness, or other nutrition counseling benefits.
TEXT: Ensuring food safety is important for all foodservice organizations including child nutrition programs (CNPs). Millions of children eat meals served at school each day. Although there have been a number of foodborne outbreaks occurred in US schools, studies show a limited number of CNPs implemented food safety self-inspection systems. Such programs start with food safety risk assessment of food procurement and preparation. To identify these risks, a questionnaire including demographics and purchasing and preparation details was developed, pilot-tested, and mailed to 1000 CNP directors nationwide. A total of 322 completed questionnaires were returned and analyzed using SPSS. A majority of respondents worked in suburban and rural areas (83.5%) with ⱕ5 elementary schools (79.2%). Many programs served foods for Head Start (19.6%), summer feeding (20.8%), and local daycare and other pre-K programs (20.8%). The majority of respondents held a high school diploma (43.4%) and some type of food safety certification (83.5%). More than 50% of programs avoided purchasing raw ground beef (85.1%), poultry (50.6%), and pork (63.7%) products and purchased pre-cooked items for food safety. Also the majority purchased fresh, not pre-washed vegetables (52.8%) and fruits (83.2%). Seventy-three respondents purchased prepared commercial foods; and 46 checked and 30 documented food temperatures on delivery. All 33 food items in the questionnaire were re-served by at least one facility after the initial service, and many meat-containing foods were reserved in ⱖ20% facilities. Findings indicate training needs for heating precooked products, washing produce, checking temperatures of commercial food deliveries, and cooling and reheating safely.
FUNDING DISCLOSURE:
FUNDING DISCLOSURE: State of Texas
A-42 / August 2004 Suppl 2—Abstracts Volume 104 Number 8
POSTER SESSION: PROFESSIONAL SKILLS/EDUCATION/MANAGEMENT/FOOD SERVICE/CULINARY TITLE: COMPARING ATTENDANCE RATE, REFERRAL TURN AROUND TIME, and PATIENT SATISFACTION IN AN OUTPATIENT NUTRITION CLINIC MODEL USING SEVERAL SATELLITE CLINIC SITES VERSUS A MODEL USING ONE CLINIC SITE AUTHOR(S): C.F. Agamao, MS; C.B. Hollenbeck, PhD; E. Guysako, MS, RD; L. McProud, PhD, RD; San Jose State University, San Jose and Santa Clara Valley Medical Center, Santa Clara, California LEARNING OUTCOME: Participants will be able to describe the effective-ness of a multi-clinic vs single clinic model in reducing clinic noshow rate and improving patient satisfaction. TEXT: Statistics for Santa Clara County Health and Hospital System show that an average of 51% of patients failed to attend their scheduled outpatient nutrition appointment. After evaluating the existing clinic model, centralization of services and a lengthy referral process was thought to contribute to the high no show rate. To improve attendance a new clinic design was implemented in which 4 satellite clinics were established within the county. The purpose of this study was to evaluate the new process by comparing the attendance rate, referral turn around time and patient satisfaction to the previous model. The 1,149 outpatients and referrals made between May and September 2002 were analyzed to determine attendance, and referral turn around time. A telephone survey was conducted to determine patient satisfaction. Results showed that the overall attendance and no show rate among return patients improved in only 1 of the 4 clinics. The no show rate among new patients was similar in all 4 clinics and did not improve with the new model. The patient survey showed that overall patients were very satisfied with the nutrition clinic service, but rated referral turn around time as somewhat satisfied. The average no show rate for other health clinics is similar to the nutrition center. Administrators should consider focusing their efforts on improving referral turn around time to improve overall clinic attendance. Strategies to improve turn around time would include increasing dietitian staff, increasing dietitian hours, and implementing classes or group sessions versus one on one counseling. FUNDING DISCLOSURE:
TITLE: IMPROVED REIMBURSEMENT AND COMMUNICATION WITH A MEDICAL MODEL “RD CHARTING TOOL” AUTHOR(S): J.A. Krenkel, MS, RD, CNSD; G. Loredo, RD, CDE; S.T. St Jeor, PhD, RD; Division of Medical Nutrition, Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV
TITLE: SUPPER MEAL IMPROVES DIETS OF CHILDREN AT NUTRITIONAL RISK AUTHOR(S): M.L.K. Plante, RD, K.S. Bruening, PhD, RD; Syracuse University, Department of Nutrition and Hospitality Management, Syracuse, NY LEARNING OUTCOME: To describe the effect of participation in a supper meal program served at an after-school child care program on food and nutrient intake. TEXT: In some states, after-school care programs serving children in low income communities are eligible for federal reimbursement for a supper meal. The purpose of this pilot study was to assess the effect of participation in the supper meal by comparing children’s food and nutrient intake on days when they participated with days when they did not. Subjects were 13 children aged 7-12 years. Dietary intake was assessed on five consecutive days using the multiple-pass 24-hour recall technique. Diet data were analyzed for macronutrients, 4 vitamins, 2 minerals, and for number of servings of Food Guide Pyramid food groups. Differences were assessed using t-tests. The 13 children (77% male) provided 58 child*days of data. On 22 of the 58 days, children ate the supper meal. When the children ate the supper meal, the number of servings of vegetables (2.7⫾1.5 vs. 1.6⫾1.5, p⫽.0087), fruits (2.3⫾1.7 vs. 1.4⫾1.4, p⫽0.0356), and milk (4.0⫾1.5 vs. 2.4⫾1.4, p⫽.0001) were greater than on days when they did not. Intakes of vitamin A (1552⫾881 vs. 730⫾419, p⬍.0001), folate (419⫾193 vs. 304⫾217 ug, p⫽.0452), and calcium (1444⫾470 vs 970⫾457 mg, p⫽.0004) were higher on days when children ate the supper meal at the after-school program. Data from the pilot study suggest that participating in the supper meal significantly diets of school-aged children. FUNDING DISCLOSURE: This project was supported by a grant from the Faculty Development Fund, College for Human Services and Health Professions, Syracuse University.
TITLE: FOOD SAFETY RISK ASSESSMENT OF CHILD NUTRITION PROGRAMS: A SURVEY OF PURCHASING AND FOOD PREPARATION PRACTICES AUTHOR(S): J. Kwon, PhD, RD, LD; Texas Woman’s University, Denton, TX
LEARNING OUTCOME: To stimulate professional evaluation of increased reimbursement and enhanced communication by using an “RD Charting Tool” based on the medical model in the outpatient clinic setting.
LEARNING OUTCOME: To increase awareness of purchasing and food preparation practices of child nutrition programs and to identify food safety training needs for child nutrition program personnel.
TEXT: Improved healthcare collaborations are needed by our healthcare system. The National Institute of Medicine recently recommended the development of an interdisciplinary effort focused on developing a common language to improve communications. The written communication in the patient’s medical chart promotes understanding of patient needs and treatment but deficiencies have been identified in the present system of charting used by dietitians in the outpatient clinic setting. Poor communication between physicians and dietitians has potential negative consequences for patient outcomes, the future of interdisciplinary and collaborative care, and reimbursement for dietitian services. We developed and tested an “RD Charting Tool” and assessment procedures based on the medical model to improve private insurance reimbursement for MNT services utilizing an MD/RD team. We contacted private insurance companies to discuss MNT reimbursement for services and found that our team approach was usually well-accepted (⬃80-90%) when MNT codes or wellness benefits were not available. The national physician standards, mandated by the American Medical Association (AMA) and Medicare, for “levels of care” and “complexity of medical decision making” patient charting in the clinical outpatient setting were revised recently and are routinely audited for compliance. Transforming charting by the RD to utilize the medical model contributed to the development of a common language, improvements in communication between physicians and dietitians, and reimbursement of dietitian services for private insurers without MNT code, wellness, or other nutrition counseling benefits.
TEXT: Ensuring food safety is important for all foodservice organizations including child nutrition programs (CNPs). Millions of children eat meals served at school each day. Although there have been a number of foodborne outbreaks occurred in US schools, studies show a limited number of CNPs implemented food safety self-inspection systems. Such programs start with food safety risk assessment of food procurement and preparation. To identify these risks, a questionnaire including demographics and purchasing and preparation details was developed, pilot-tested, and mailed to 1000 CNP directors nationwide. A total of 322 completed questionnaires were returned and analyzed using SPSS. A majority of respondents worked in suburban and rural areas (83.5%) with ⱕ5 elementary schools (79.2%). Many programs served foods for Head Start (19.6%), summer feeding (20.8%), and local daycare and other pre-K programs (20.8%). The majority of respondents held a high school diploma (43.4%) and some type of food safety certification (83.5%). More than 50% of programs avoided purchasing raw ground beef (85.1%), poultry (50.6%), and pork (63.7%) products and purchased pre-cooked items for food safety. Also the majority purchased fresh, not pre-washed vegetables (52.8%) and fruits (83.2%). Seventy-three respondents purchased prepared commercial foods; and 46 checked and 30 documented food temperatures on delivery. All 33 food items in the questionnaire were re-served by at least one facility after the initial service, and many meat-containing foods were reserved in ⱖ20% facilities. Findings indicate training needs for heating precooked products, washing produce, checking temperatures of commercial food deliveries, and cooling and reheating safely.
FUNDING DISCLOSURE:
FUNDING DISCLOSURE: State of Texas
A-42 / August 2004 Suppl 2—Abstracts Volume 104 Number 8