PROGRAM EVALUATION OF REFERRAL AND SERVICE DELIVERY OF MEDICAL NUTRITION THERAPY (MNT) SERVICES AT SILER CITY PIEDMONT HEALTH

PURPOSE Type 2 diabetes mellitus (T2DM) is a growing health concern in the United States and a leading cause of death among older Latino individuals. This chronic disease is associated with multiple complications, including neuropathy, cardiovascular disease, retinopathy, and foot disease. Evidence-based management strategies include pharmacologic therapy, diabetes self-management education and support, and medical nutrition therapy (MNT). Medical nutrition therapy alone has been shown to reduce hemoglobin A1C by up to 2%, and referrals are recommended at four critical time points in diabetes care. Despite these recommendations, referral and utilization of MNT services remain inconsistent in many community health settings.METHODS This program evaluation was conducted at Siler City Piedmont Health, a federally qualified health center providing MNT services to patients with T2DM with a predominantly Latino clinic population. A three-month evaluation, using the Context, Input, Process, Product (CIPP) evaluation framework, assessed the effectiveness and utilization of existing MNT services. Quantitative descriptive data and qualitative data from staff surveys were collected to evaluate referral patterns, scheduling processes, and staff perceptions related to MNT service delivery.RESULTS Among 123 eligible adult patients with T2DM, 38.2% (n = 47) were scheduled for MNT services. Of those scheduled, 72.3% (34/47) completed at least one MNT visit, and 76.5% (26/34) occurred within 30 days of scheduling. Only 2.4% (3/123) of eligible patients declined scheduling, while 23.4% (11/47) of scheduled visits were not completed due to cancellation or no-show. Qualitative findings revealed variability in documentation practices, limited use of standardized scheduling tools, and differing staff perceptions regarding patient engagement and workflow efficiency. Staff also identified structural challenges related to scheduling processes, competing clinic priorities, and uncertainty regarding implementation of telehealth services.CONCLUSIONS Findings suggest that system-level processes and scheduling workflows influence MNT referral and participation rates. Recommendations included promoting preventive care visits to facilitate referrals, expanding bilingual registered dietician (RD) capacity, exploring telehealth options to improve access, and further evaluating patient-level barriers to MNT participation. Overall, findings suggest that staff are receptive to improving MNT services but require clearer workflows and structural support to optimize program changes.