U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Planning, Evaluation & Research

RRM Category: AMBULATORY CLINICS

RRM Module: Ambulatory Nutrition Services

Overview:
The RRM Ambulatory Nutrition Services staffing module estimates the requirements for Registered Dietitians (RDs) who work primarily in outpatient clinical settings and provide one-on-one medical nutrition therapy (MNT) for individuals with complex medical conditions, such as type 2 diabetes, obesity and chronic kidney disease. These services can also be provided in a group setting. RDs working in ambulatory nutrition services function as case and care managers, monitor outcomes of MNT and adjust treatments, and coordinate communication among multiple levels of health care professionals. Additionally, they refer clients to appropriate community resources. The workload parameter that is the key variable in the staffing estimation is Primary Care Patient Visits (PCPVs). This module estimates the need for Registered Dietitians and Support Staff for ambulatory care nutrition services. Support Staff are Clerks and/or Dietitian/Nutrition technicians and mix will be determined by the facility Chief Dietitian.

Services Description:

Ambulatory Nutrition Services includes:

  • Providing MNT to individuals, families and groups
  • Function as a case manager/care coordinator in clinical and home health programs serving medically high-risk clients
  • Implementing standards of care
  • Conducting nutrition assessments of individuals and developing nutrition care plans
  • Counseling individuals and families on nutrition needs, eating habits, physical activity and other lifestyle modifications
  • Referring clients to appropriate community resources
  • Evaluating clinical care outcomes
  • Providing other nutrition services, such as health promotion disease prevention activities, in the community as available and needed.
  • Acting as a liaison with community and other health resources
  • Participates in multidisciplinary committees, staff meetings and conferences and other administrative duties as assigned

Staffing Criteria:

1.1 Registered Dietitian per 10,000 PCPVs for the first 60,000 PCPVs then 0.55 FTE for every 10,000 PCPVs.
0.5 Support Staff per 10,000 PCPVs for the first 60,000 PCPVs then 0.25 FTE for every 10,000 PCPVs.

Personnel Categories:
Registered Dietitian
Support Staff (Dietetic or Nutrition Technician/Clerical Support with mix determined by the facility Chief Dietitian)

Driving Variables:
Primary Care Provider Visits

MINIUM STAFFING LEVELS (fixed):
All staffing levels are variable, based on PCPVs.

VARIABLE STAFFING LEVELS:

Personal Category FTEs per Driving Variables Min. Max.
Registered Dietician 1.1 10,000 PCPV n/a 60,000
Support Staff (Clerical and Technical) 0.50 10,000 PCPV n/a 60,000
Registered Dietician 0.55 10,000 PCPV 60,001 n/a
Support Staff (Clerical and Technical) 0.25 10,000 PCPV 60,001 n/a


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