Dawn W. Blackhurst

Assessing dietary fat intake in chronic disease rehabilitation programs.

PURPOSE Previous work has established that the Heart Fit Rx Diet Habits Survey (HFD), formerly the Food Frequency Assessment Tool, compares favorably (r = 0.78; P <.01) with the Oregon Health Sciences University Diet Habit Survey. The purpose of this study was to assess the validity and reliability of the HFD in estimating fat intake as a percentage of calories. METHODS The validity study assessed 137 patients undergoing cardiac rehabilitation (age, 60.7 +/- 11.3 years) who completed the HFD (29 questions, 11 of which were dietary fat related [fat subscore]) and a 3-day food record. A regression equation was obtained using HFD subscores to estimate fat intake as a percentage of calories. The regression equation was tested using 50 patients not included in the original cohort. Reliability was assessed using a third group of 31 patients in a 4-week test-retest analysis. RESULTS The correlation coefficient between the 3-day record and the HFD fat subscore was 0.65 (P <.01). The correlation coefficient for women (r = 0.77) was slightly higher than for men (r = 0.62). The regression equation derived from the HFD fat subscore was as follows: percentage of dietary fat = 50.65 - 0.736 (HFD fat subscore). The correlation coefficient for actual and predicted values was 0.58 (P <.01). Differences between estimated fat intake, as determined by the 3-day record and the HFD, ranged from 0% to 25% and were within 5% for 26 of the 50 subjects (52%), and within 10% for 41 of the 50 subjects (82%). The mean difference between the two measures was 1.5% (P =.17). Test-retest reliability was high for both the HFD total score (r = 0.95) and the HFD fat subscore (r = 0.85; P <.01). CONCLUSIONS The HFD is an inexpensive, valid, and reliable clinical instrument for assessing dietary fat. It can be a viable alternative to other time-consuming methods, including computerized analysis.

Implementing High-Value Care.

Objectives Our objectives were to assess physician knowledge of costs of products, tests, and services commonly used by obstetrician/gynecologists (OB/GYNs) and identify those items that could be eliminated without decreasing quality of care by performing a prospective observational pilot study. Methods An anonymous electronic survey was distributed to 70 OB/GYN providers at Greenville Memorial Hospital. Survey items included common laboratory tests, medications, and clinical services. The survey was used to identify items with high cost for which there were less costly but equally efficacious alternatives. As an educational intervention, grand rounds reviewing the survey results, as well as recommendations that would allow for lean healthcare changes, were conducted. Utilization and cost savings were tracked for a 1-year preintervention and a 1-year postintervention. Results In total, 50 of 70 providers (71%) completed the survey. Hydrocortisone acetate/pramoxine hydrochloride and dinoprostone vaginal inserts were targeted for intervention. Use of the dinoprostone vaginal insert decreased 50.5% with a savings of

Factors Influencing Health-Related Quality of Life in Cardiac Rehabilitation Patients

66,500 when comparing the preintervention period with the postintervention period. Use of hydrocortisone acetate/pramoxine hydrochloride decreased 90% with a savings of

A Simple Diet Assessment Instrument: S-7

92,655. Combined, the decreased use of these products led to a

Assessing Dietary Fat Intake in Chronic Disease Rehabilitation Programs

159,155 cost savings in the 1-year postintervention period. Conclusions OB/GYN providers at our institution had a poor working knowledge of costs. Through the use of a survey and educational intervention, we demonstrated that simple interventions could lead to high-quality, lean healthcare changes.