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Constructs

Construct Details

Construct Name:	Dietary Assessment
Definition of Construct:	A dietary assessment is a comprehensive evaluation of a person's food intake. It is one of four parts of a nutrition assessment done in a clinical setting. These four parameters of assessment include: (1) an assessment of anthropometrics (weight, height, weight-to-height ratio, head circumference, body mass index , etc.); (2) dietary assessment, which includes a diet history or food frequency analysis; (3) a physical examination with a medical history; and (4) biochemical exams or blood/urine tests.
Theoretical Foundation:
Synonyms for Construct:
Similar Constructs:
Associated Constructs
Keywords:	EHR Candidate

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Measures

Datasets

Start the Conversation (STC) (EHR Campaign)

Binge Eating Scale-BES

NCI Fruit and Vegetable Screener (EHR Campaign)

NCI Energy from Fat Screener (EHR Campaign)

(Last Updated: 2/22/2011 12:08:18 PM by Dave Garner)

Comments (25 comments)

EHR Campaign Evaluation, 4/10/2011 7:25:23 PM By Laura Hayman, UMass Boston College of Nursing & Health Sciences Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 4 NCI Fruit and Vegetable Screener (EHR Campaign) = 4 Start the Conversation (STC) (EHR Campaign) = 5 Recommendations
EHR Campaign Evaluation, 4/8/2011 7:12:34 PM By Deborah Toobert, Oregon Research Institute Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 3 NCI Fruit and Vegetable Screener (EHR Campaign) = 5 Start the Conversation (STC) (EHR Campaign) = 4 Recommendations
EHR Campaign Evaluation, 4/8/2011 5:14:57 PM By Abdel Fahmy, Access Community Health Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 4 NCI Fruit and Vegetable Screener (EHR Campaign) = 5 Start the Conversation (STC) (EHR Campaign) = 4 Recommendations
EHR Campaign Evaluation, 4/8/2011 3:01:20 PM By Thomas Land, Mass Dept of Pub Health Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 1 NCI Fruit and Vegetable Screener (EHR Campaign) = 1 Start the Conversation (STC) (EHR Campaign) = 2 Recommendations
EHR Campaign Evaluation, 4/6/2011 4:54:57 PM By Barbara Fletcher, University of North Florida Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 5 NCI Fruit and Vegetable Screener (EHR Campaign) = 5 Start the Conversation (STC) (EHR Campaign) = 5 Recommendations
EHR Campaign Evaluation, 4/4/2011 3:55:56 PM By Alex Krist, Virginia Commonwealth University Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 1 NCI Fruit and Vegetable Screener (EHR Campaign) = 1 Start the Conversation (STC) (EHR Campaign) = 3 Recommendations I think that asking dietary questions in primary care is a major challenge. The first reason that this is difficult is that a major reason to ask these questions is to "screen" patients for dietary issues. While the measures are nice to systematically approach this, they are cumbersome to administer in primary care. Additionally, the type and depth of questions a patient should be asked varies depends on their individual clinical scenario. For exampleit makes sens to ask different questions to a patient with uncontrolled blood pressure vs a patient who is overweight vs a patient who is completely healthy. I imagine that what would be of importance here would be to determine what are the best measures to administer to all patients. Such a set of measures should be as simple as possible. The NCI measures and the STC measure are all good, but too detailed to ask everyone. A second challenge is that the patient responses should be actionable. Meaning primary care practices should be able to help patients make meaningful improvements with patient responses. It is difficult to figure out how to respond to patient responses on these measures. For example, how does a clinician respond to a patient who says they have 2-3 desserts or only has 1 serving of beans over the past month?
EHR Campaign Evaluation, 4/4/2011 3:20:40 PM By Jessica Kasirsky, NextGen Healthcare Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 3 NCI Fruit and Vegetable Screener (EHR Campaign) = 3 Start the Conversation (STC) (EHR Campaign) = 4 Recommendations There does not seem to be a timeline indicated here. Would this be once a reporting period?
EHR Campaign Evaluation, 4/4/2011 1:10:28 PM By Doug Fernald, University of Colorado Department of Family Medicine Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 3 NCI Fruit and Vegetable Screener (EHR Campaign) = 2 Start the Conversation (STC) (EHR Campaign) = 5 Recommendations NCI Fat Screener: Nice and compact, but too long for routine screening. NCI Fruit and Veg: Too long and too much detail about vegetables. STC: Reasonable length and has now been tested in frontline primary care with good results. Balanced assessment of fruit and veg, quality proteins, snacks. (1. Fernald DH, et al. Common measures, better outcomes (COMBO): a field test of brief health behavior measures in primary care. American journal of preventive medicine. 2008 Nov ;35(5 Suppl):S414-22.) A single fruit and vegetable question for initial screening might work well, too.
EHR Campaign Evaluation, 4/3/2011 4:13:45 PM By Perry Dickinson, University of Colorado School of Medicine Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 3 NCI Fruit and Vegetable Screener (EHR Campaign) = 3 Start the Conversation (STC) (EHR Campaign) = 4 Recommendations In order to be usable in primary care, these are going to need to be stripped down to only a few items - one or two each for fat and fruits/veggies.
EHR Campaign Evaluation, 4/3/2011 8:23:47 AM By Russ Glasgow, Institute for Health Research, Kaiser Permanente Colorado, (Denver CECCR) Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 2 NCI Fruit and Vegetable Screener (EHR Campaign) = 5 Start the Conversation (STC) (EHR Campaign) = 4 Recommendations Thanks to the work group for their efforts on this. These recommendations seem practical- and especially the STC seems directly actionable Very tough area in which to get down to a few items.
EHR Campaign Evaluation, 4/3/2011 8:23:02 AM By Russ Glasgow, Institute for Health Research, Kaiser Permanente Colorado, (Denver CECCR) Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 2 NCI Fruit and Vegetable Screener (EHR Campaign) = 5 Start the Conversation (STC) (EHR Campaign) = 4 Recommendations Thanks to the work group for their efforts on this. These recommendations seem practical- and especially the STC seems directly actionable Very tough area in which to get down to a few items.
EHR Campaign Evaluation, 4/1/2011 1:08:10 PM By Hardeep Singh, Houston VA and Baylor College of Medicine Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 1 NCI Fruit and Vegetable Screener (EHR Campaign) = 1 Start the Conversation (STC) (EHR Campaign) = 1 Recommendations Diet is clearly an important construct but we need to clarify the rationale of why all this data is being collected and what will be done with it. I believe in practice, we really want to focus on patients who are at risk for some reason e.g. high or low BMI, DM, HTN, lipids, CAD etc.. The important issue is that these high-risk patients are identified and if needed referred to a nutritionist to do a more detailed assessment. Its not clear how the proposed measures will be meaningfully collected and integrated with EHRs and be used effectively by PCPs or others. In my opinion, what we need is to think about what are the criteria based on which some of these detailed measurements need to be collected (by someone other than the PCP, perhaps a diectician).
EHR Campaign Evaluation, 3/29/2011 2:00:38 PM By Marian Fitzgibbon, University of Illinois at Chicago After reviewing a number of measures, it seems that the STC is proably the best for a primary care setting. It is simple to complete and provides direction for the primary care provider without having to use a more complicated scoring routine.
EHR Campaign Evaluation, 3/29/2011 1:55:54 PM By Marian Fitzgibbon, University of Illinois at Chicago Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 3 NCI Fruit and Vegetable Screener (EHR Campaign) = 3 Start the Conversation (STC) (EHR Campaign) = 5 Recommendations
EHR Campaign Evaluation, 3/28/2011 6:59:24 PM By seana zagar, OCHIN Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 2 NCI Fruit and Vegetable Screener (EHR Campaign) = 2 Start the Conversation (STC) (EHR Campaign) = 4 Recommendations NCI measures are too long and complex for routine use in primary care. STC items provide reasonable baseline info to which further assessment could be added if problems were identified.
EHR Campaign Evaluation, 3/28/2011 5:03:53 PM By Jennifer Carroll, University of Rochester Medical Center, Department of Family Medicine Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 2 NCI Fruit and Vegetable Screener (EHR Campaign) = 2 Start the Conversation (STC) (EHR Campaign) = 4 Recommendations I like the STC measure and could see it being relatively easy to adopt in primary care settings. The NCI fat and F&V; measures, while being useful for dietician consultations and having data of interest to primary care physicians for their patients, would be quite difficult for most primary care settings to implement due to the length.
EHR Campaign Evaluation, 3/27/2011 4:26:34 PM By Gary Bennett, Duke University Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 2 NCI Fruit and Vegetable Screener (EHR Campaign) = 2 Start the Conversation (STC) (EHR Campaign) = 4 Recommendations
EHR Campaign Evaluation, 3/26/2011 7:52:07 PM By Lisa Klesges, University of Memphis Measure Ratings NCI Energy from Fat Screener (EHR Campaign) = 3 NCI Fruit and Vegetable Screener (EHR Campaign) = 3 Start the Conversation (STC) (EHR Campaign) = 5 Recommendations
Longer but better to include recall and FFQ options, 3/17/2011 11:30:07 AM By William Riley, NHLBI NCI has developed internet-based, automated forms of 24 hr. dietary recall (ASA-24) and food frequency questionnaires (DHQ). Although much greater response burden than the measures being considered, these can be administered to patients at any time and any place, and each will provide good estimates of calories and macronutrient consumption not provided by these short self-report measures. Actual calorie and macronutrient estimates are much more actionable outputs for PCPs.
EHR Campaign Evaluation, 3/16/2011 11:43:07 AM By Maureen Boyle, NIH, OBSSR Measure Ratings NCI Energy from Fat Screener = 3 NCI Fruit and Vegetable Screener = 3 Start the Conversation (STC) = 4 Recommendations The STC looks great but it is a little long to include at every visit. Perhaps a dietary assessment could be done on a yearly basis instead of at each visit.
EHR Campaign Evaluation, 3/14/2011 7:18:29 PM By karen emmons, dfci/hsph Measure Ratings NCI Energy from Fat Screener = 3 NCI Fruit and Vegetable Screener = 3 Start the Conversation (STC) = 5 Recommendations
diet assessment, 3/14/2011 7:17:28 PM By karen emmons, dfci/hsph I very much like the STC measure. It is very actionable, and broader than the F & V screener.
EHR Campaign Evaluation, 3/3/2011 10:03:23 PM By Jerry Suls, University of Iowa/Resident IPA NCI (8/2010-8-2011) Measure Ratings NCI Energy from Fat Screener = 4 NCI Fruit and Vegetable Screener = 4 Start the Conversation (STC) = 4 Recommendations
EHR Campaign Evaluation, 2/28/2011 8:24:49 AM By Erin Hennessy, NCI Measure Ratings NCI Energy from Fat Screener = 3 NCI Fruit and Vegetable Screener = 3 Start the Conversation (STC) = 4 Recommendations The STC instrument appears to be a good, reliable, user-friendly tool to engage patients. One concern I would raise is regarding the scoring procedures, which seem counterintuitive (lower scores = more healthful diet). I wonder if this was ever discussed with patients during the development and testing? Eventually it would be nice to see a tool that had a bit more synergy with the DGAs (dietary guidelines for americans), but the STC seems like an excellent start.
Health Policy Committee Statement, 2/23/2011 5:53:49 PM By Alicia Sukup, Society of Behavioral Medicine Comment by the Dietary Assessment working group. Starting the Conversation (STC)1 is an 8-item dietary screening instrument, available in both English and Spanish that is designed for use by non-dietetic staff in clinical settings. STC assesses frequency of intake of fast-food meals, fruit, vegetables, regular soda or sweet tea, beans, chicken fish, regular snacks chips or crackers, desserts/other sweets, and margarine, butter or meat fat. Each response is scored from 0 - 2. The instrument is scored by tallying the responses to each of the 8 items (range -0 -16). Higher numbers reflect a less healthy diet and lower numbers reflect a more healthy diet. To test the validity of the STC, scores were compared to fat intake measured by the National Cancer Institute (NCI) Percentage Energy from Fat Short Instrument (PFat). Respondents were randomly selected adult patients (mean age = 58 years; mean body mass index = 34.8 kg/m2), with type 2 diabetes (n =463) who completed the measures at baseline and four months following participation in an interactive diabetes self-management intervention with a goal of reducing dietary fat. Correlations with the PFat were (r= 0.39 – 0.59, p < .05) at baseline and (r = 0.22, p < .05) following the 4-month intervention. The STC score remained relatively unchanged at four months in individuals who did not participant in the intervention. (r = .66, p < .05). The STC was determined to be sensitive, with the intervention showing a significant reduction in the total score vs. the control group (M = 1.16 vs. 0.46, p < .05). A limitation of the STC is that it has not been validated against a known standard of dietary intake in a large trial and these initial data are from a single site. However, two other validated and widely used measures of usual dietary intake, including the NCI 19-item Fruit and Vegetable Screener (FVS) and the 16-item NCI PFat, were reviewed and considered not sufficiently user-friendly in terms of length and interpretability for a primary care setting. 1. Paxton AE. American Journal of Preventive Medicine 2011; 40 (1) 67-71. Dietary Assessment working group consists of Marian Fitzgibbon, Susie Nanny, Guadalupe Compean.