(P21-002-23) Dietary Counseling Among Patients With Recent Hospitalization for Cardiovascular Disease

Objectives: Dietary advice is the cornerstone for cardiovascular disease (CVD) management and is provided by registered dietitian nutritionists (RDN) and other clinicians. We hypothesized that dietary advice is infrequently documented in medical claims after hospitalization for CVD.

Methods: We used the Michigan Value Collaborative multi-payer claims data registry that includes all patients from >100 hospital in Michigan. We sought to determine frequency of medical claims that document dietary advice within 90 days of hospitalization for CVD events (coronary artery bypass grafting (CABG), acute myocardial infarction (AMI), congestive heart failure (CHF), and percutaneous coronary intervention (PCI)) from 10/2015–2/2020. We defined dietary advice receipt as encounter level International Classification of Diseases 10th Revision code for either dietary advice or current procedural terminology code for medical nutrition therapy or cardiac rehabilitation (CR; dietary advice is a standard part of CR). We used multivariable logistic regression to understand variation in documentation across age, gender, rurality, chronic kidney disease, diabetes, obesity, and CVD event.

Results: There were 175,631 episodes of care among 146,185 individuals. CHF had the most episodes (47.1%), followed by AMI (28.7%), PCI (17.0%), and CABG (7.3%). Most episodes occurred among males (55.8%) and those >65 years (71.9%). Diabetes was more common (50.0%) than obesity (18.2%), or chronic kidney disease (11.7%). Dietary advice was documented for 22.8% of episodes and more common as CR codes (18.6%) than other encounters (5.1%). In multivariable analysis, dietary advice was less likely (OR, p-value) to be coded for those >65 years (0.81, < .001), females (0.82, < .001), with chronic kidney disease (0.74, < .001), or with diabetes (0.94, < .001), but more likely for those with obesity (1.28, < .001) and in rural areas (1.32, < .001). Compared to CABG, AMI (0.28, < .001), CHF (0.12, < .001), and PCI (0.37, < .001) were less likely to have dietary advice coded.

Conclusions: Dietary advice is infrequently documented in medical claims within 90 days after hospitalization for CVD episodes with most related to cardiac rehabilitation. Medical claims did not retain if advice was provided by an RDN since billing may be done under other clinicians.

Funding Sources: Blue Cross Blue Shield of Michigan Foundation