Comparison of 1983 and 1992 renal dietitian staffing levels with patient morbidity and mortality
Abstract •■ Objective: To compare 1992 and 1983 renal dietitian staffing patterns in relation to changes in patient age, morbidity, and mortality. •■ Design: Data were obtained by survey research. The original questionnaire used in 1983 was maintained and mailed for data collection in 1992. Existing records provided age, morbidity, and mortality data. •■ Setting: Research was coordinated through the Nutrition Services department at the Northwest Kidney Centers, Seattle, Washington. Data were collected from dialysis centers in the Northwest Renal Network No. 16 (WA, OR, AK, ID and MT). •■ Subjects: Characteristics of Network No. 16's dialysis patient population and the nutritional service provided by renal dietitians were examined in 19 of the 29 kidney dialysis centers existing in 1983 and all 57 centers existing in 1992. •■ Main outcome measures: Renal dietitian hours per patient per month, patient characteristics (number of patients served, age, morbidity, mortality ratio, and cause of death), and dialysis center characteristics (size and profit status). •■ Statistical analysis performed: Examination of the original 19 centers over time was analyzed either by a paired t-test or a sign test. A t-test was used to compare means from all centers in 1983 and 1992. Correlation coefficients were calculated to measure relationships between reported variables. •■ Results: Between 1983 and 1992, the number of kidney centers and dialysis patients doubled, with the greatest increases observed in the numbers of patients with diabetes and diseases of connective tissue. People with diabetes accounted for 50% of all new patients. The patient population was approximately 5 years older, with crude mortality increasing significantly from 17% to 28%. Cardiac-related deaths increased significantly from 34% to 54%. Average dietitian hours per patient per month increased from 0.8 hours in 1983 to 1.1 hours in 1992. More dietitian staffing was provided in larger centers and in nonprofit centers. A significant increase in dietitian staffing was observed in patients dialyzing in-center rather than at home. •■ Conclusions: Between 1983 and 1992, renal dietitian staffing increased by 18 minutes per patient per month. Considering that the patient population became older and sicker (primarily because of diabetes), had a higher mortality, and comprised a larger proportion dialyzing in-center rather than at home, the increase in 18 minutes per patient per month may be inadequate.