Paper Type

Doctoral Dissertation


Brooks College of Health

Degree Name

Doctor of Clinical Nutrition (DCN)


Nutrition & Dietetics

NACO controlled Corporate Body

University of North Florida. Department of Nutrition & Dietetics

First Advisor

Dr. Lauri Wright

Second Advisor

Dr. Andrea Arikawa

Rights Statement

Department Chair

Dr. Lauri Wright

College Dean

Dr. Curt Lox


The purpose of this study was to examine documentation quality and outcomes in a sample (n = 564 patient cases) of Diabetes Registry data from ANDHII, and to determine the validity and reliability of a revised NCP quality audit tool. RDNs have struggled to objectively demonstrate the value of MNT, which has limited MNT reimbursement and RDN recognition amongst allied healthcare providers. Development of a standardized process (the NCP), standardized language (the NCPT), and ANDHII have provided a means through which RDNs can improve MNT documentation and capture outcomes data, but gaps in adequate utilization exist. The most common etiology term used in the Nutrition Diagnosis was food and nutrition related knowledge deficit (56.65%) despite knowledge-based Nutrition Assessment terms representing less than 3% of all Nutrition Assessment terms used. Nutrition Interventions were mostly derived from the Nutrition Education domain (63.88%) with only 4.04% of Nutrition Interventions derived from the Nutrition Counseling domain. Only 146 patient cases (26%) had at least one follow-up visit (M = 1.40 visits). Factors most significant for predicting problem resolution included presence of the evidence-diagnosis link (p = .033) and location (p =.001). The revised NCP quality audit tool was found to have high validity (relevance: S-CVI-UA = .958, S-CVI-Ave = .979; clarity: S-CVI-UA = .917, S-CVI-Ave = .958), moderate inter-rater reliability (a = .668), and low to moderate intra-rater reliability (rater CC a = .860, rater MC a = .319). The revised tool exposed disparities in RDN documentation of clear NCP linkages not previously captured from the existing Diet-NCP-Audit tool. Better training for RDNs in the NCP, NCPT, and ANDHII, as well as improvements in NCP application is critical. RDNs must improve NCP and NCP linkages documentation, and capture outcomes through ANDHII in order to elevate the dietetics profession, expand MNT accessibility, and improve global health.