Online Program

Increasing value to medical practices and public health: Adding embedded registered dietitians and diabetes educators to improve team-based care

Monday, November 2, 2015 : 9:10 a.m. - 9:30 a.m.

Karen Anthony, MS, CHES, Department of Family & Community Medicine, Christiana Care Health System, Wilmington, DE
Kathy A. Cannatelli, MS, Department of Family & Community Medicine, Christiana Care Health System, Wilmington, DE
Omar Khan, MD, MHS, FAAFP, Primary Care & Community Medicine, Christiana Care Health System, Wilmington, DE

Medical practices are increasingly struggling with demands on their time, and increasing patient volume and complexity.  Our health system is one of the largest in the country, and provides an array of partner practices in which to pilot an intervention utilizing Registered Dietitians (RDs) Certified Diabetes Educators (CDEs).   We sought to embed the RD/CDE in the partner practice rather than at an offsite location as is more customary, to eliminate barriers for patients and referring providers.


We worked with practices and groups whose patient populations were particularly impacted by food & nutrition issues, i.e. office practices of Cardiology/Heart Failure, the Visiting Nurses Association’s home visits, Neurology clinic and Primary Care (Family Medicine & Internal Medicine).

Pre-program meetings were conducted with the clinics’ medical directors and nursing leads, as well as with our own group. Models of care were established for each practice, with emphasis on prevention through nutrition counseling and diabetes education.  A system of ‘warm handoffs’ was instituted to provide continuity and patient/provider satisfaction.


RDs were successfully embedded in 3 specialty practices (cardiology/ congestive heart failure clinic; neurology; and the Visiting Nurses Association) and 3 primary care practices (two Family Medicine and one Internal Medicine).  Early results demonstrate positive changes in patient care as evidenced by improved patient self-management; improved management of specialty conditions; integrated care; and high provider satisfaction.


Nutrition education for conditions particularly amenable to counseling (such as obesity, heart failure, and diabetes) increases self-management of risk factors for chronic diseases. Embedding RDs in clinical practices with attention to patient needs and practice dynamics can be an essential aspect of the overall care of patients and populations.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public

Learning Objectives:
Discuss the value to medical practices and the public’s health of registered dietitians embedded in the practice. Discuss the role of team-based care in improving patient and provider satisfaction. Describe the process of warm handoffs, co-location vs. embedding, and other lessons learned for integrated care.

Keyword(s): Chronic Disease Management and Care, Patient-Centered Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the Program Manager of outpatient nutrition services and diabetes self-managment education as well as primary care disease management services for many years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3060.0: Integrated care