Perspectives, Issues in practice, Processes for improvement
by: Laura D. Byham-Gray
Department of Primary Care,
Graduate Programs in Clinical Nutrition,
University of Medicine and Dentistry of New Jersey,
School of Health Related Professions,
University Educational Center, Strtford, NJ
Despite greater access to health care and advances in medicine and technology, the morbidity and mortality among patients diagnosed with chronic kidney disease (CDK) remain unacceptably high discrepancies in patient care outcomes exist between the United States and other industrialized countries and and are partly explained by variances reported in clinical practice.
Outcomes research (OR) has been the primary methodology used to more fully explore the root causes for the practice variation and to uncover which indicaors have the greatest impact.
Research has established the relatioships between early diagnosis and treatment, cardiovascular disease, quality of life, and malnutrition with morbidity and mortality rates among patients with kidney disease.
Although nutrition parameters are predictive of mortality, they are complex to understand and even more difficult to improve, largely because of the effects of the imflammatory process and the lack of direct measure that defines nutritional status.
Future OR projectsmust focus on specific nutrition-related outcomes and the effectiveness of intervention, as these outcomes can establish clinical guidelines, lead to changes in practice, and create more controlled clinical trials that continue to search for answer to questions on the impact of nutrition and others.
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