LEARNING OUTCOME:To understand the information required by case managers by dietitians for reauthorization of nutrition therapy.

The dietitian and the case manager can form a partnership to merge the goals of each party to provide quality patient care that is cost effective. Dietitians establish this relationship by listening to the case manager to discover what information is essential to them. In our experience, case managers require a statement of medical necessity, measurable short and long term goals of therapy, and clinical follow-ups on a consistent basis. This dietitian worked closely with the case manager on a patient with HTV/AIDS that was prescribed TPN for diarrhea and 35 pound weight loss secondary to Microsporidia. The initial nutrition assessment documented the medical necessity of TPN including decreased GI integrity and nutrient malabsorption. The goals of treatment were established to provide 100% of estimated nutrition and hydration needs with TPN, to promote weight gain of 1-2 pounds per week, and taper the TPN with a decrease in stool output. The Microsporidia was treated and diarrhea subsided, however, the patients oral intake remained inadequate. Absorption studies were completed and a gastrostomy tube was considered as a more clinically appropriate and cost effective means of providing nutrition support with a functional GI tract. In the transition phase, specific goals of therapy were provided to the case manager on a weekly basis, including the weight goal and TPN tapering schedule with the specific dates and calories. By providing specific details of the nutrition plan, to the case manager, we were able to maintain authorization of the TPN until adequate enteral nutrition (oral or tube feedings) and weight maintenance were established.