Current fellow of The Academy of Nutrition and Dietetics Foundation - - PDF document

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Current fellow of The Academy of Nutrition and Dietetics Foundation - - PDF document

Feb 14, 2024 164 likes •318 views

6/12/2019 A Study to Validate the Malnutrition Clinical Characteristics and Quantify Dietitian Staffing Levels to Improve Medical Outcomes Courtney Bliss, MS RDN CNSC June 7, 2019 AZAND Annual Conference Together Towards Tomorrow 1 /

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Courtney Bliss, MS RDN CNSC June 7, 2019 AZAND Annual Conference “Together Towards Tomorrow” A Study to Validate the Malnutrition Clinical Characteristics and Quantify Dietitian Staffing Levels to Improve Medical Outcomes

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Disclosures

Current fellow of The Academy of Nutrition and Dietetics Foundation

  • Supporting study execution

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Learning Outcomes

Upon completion of this presentation, attendees will be able to describe current:

  • MCC/NFPE evidence
  • RD staffing metrics
  • AND malnutrition initiatives
  • needs in acute care nutrition assessment and

diagnosis of malnutrition

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Overview

  • About me
  • Malnutrition and Assessment
  • Outcomes
  • Staffing
  • MCC and Staffing Study
  • Advanced research training opportunities
  • Questions

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About Me

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Current Status of Malnutrition

Incidence

  • Approx 4% hospitalized pediatric patients are

malnourished

  • An estimated 50% of adult hospitalized patients

are at risk

Underdiagnosed, undertreated in hospitalized patients Longer LOS and higher hospital costs No gold standard for diagnosis

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Current Nutrition Assessment

Screening tools

  • STAMP, STRONGKids
  • MST

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Current Nutrition Assessment

Subjective Global Assessment Nutrition Focused Physical Exam (NFPE)

  • Fat & Muscle Wasting
  • Micronutrient Deficiencies

Biochemical markers

  • Albumin, prealbumin, CRP

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Malnutrition Clinical Characteristics

MCC for adults include insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, fluid accumulation, and diminished functional status (measured via hand grip strength)

  • The presence of two or more of the clinical

characteristics can be used to establish the diagnosis of malnutrition Consensus decision – not validated measures or tools

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Malnutrition Clinical Characteristics

MCC for pediatric patients, when only one data point is available, the recommended MCC include weight-for- height/length z-score, body mass index for age z-score, length/height-for-age z-score, and mid-upper arm circumference z-score.

  • When additional data points are available,

recommended indicators include weight gain velocity for children <2 years old, weight loss for children 2-20 years of age, deceleration in weight- for-length/height z-score, and inadequate nutrient intake. Consensus decision – not validated measures or tools

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Current Staffing Metrics

Varies by state and patient populations Presumed best practice vs legal protections

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Current Needs

Validation of MCC

  • No systematic, universally accepted method of

diagnosing malnutrition Need for large scale data across populations and regions

  • Malnutrition prevalence in hospitalized patients

Best practice for staffing

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MCC and Staffing Study Overview

Goal is to validate MCC against medical

  • utcomes

Quantify RD care/time required to improve

  • utcomes

Results will inform staffing levels for inpatient

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Study Design

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Nutrition and Medical Outcomes

Primary medical outcomes for study are Length

  • f Stay (LOS), mortality/morbidity, and

readmissions/ED visits after discharge DRG is a confounder/covariate

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Recruitment and Enrollment Goal

  • 60-120 facilities
  • 6 host sites
  • Approx 4800 subjects

Current numbers

  • Working with ~65 adult facilities
  • Working with ~42 pediatric facilities

Staggered training and enrollment Subject enrollment to begin in July

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Benefits Networking Continuing Education and Training Participation in national initiatives with framework and support staff FUN!!

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Current Experiences

Networking Recruitment to non-Academy members Clinicians as researchers

  • Research experience
  • Generational differences

Hospital systems Protected research time Host/Training Site Recruitment

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Advanced training

  • Non-traditional methods
  • Providing CEUs as part of research training
  • Participation in national initiatives
  • Fellowships
  • Improved practice, stronger teams,

improved patient outcomes

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Fellowship

  • Collaborative effort
  • Advance skills
  • Unique educational opportunities
  • Expand practitioner expertise, including

leadership skills

  • Demonstrate RDN value
  • Networking
  • Passion

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My Experience

  • Collaborative effort
  • Networking
  • Advance skills
  • Research
  • Leadership
  • Unique educational opportunities
  • Demonstrate RDN value

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Together Towards Tomorrow

  • MCC and NFPE as standard of care
  • Large scale nutrition research utilizing

clinicians

  • Standardized recommendations
  • Diversified training opportunities
  • RDNs better situated to affect change

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Thank you! Questions?

Study Email: MCC@eatright.org My Email: feedingbliss@gmail.com

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References

Lakdawalla DN, Mascarenhas M, Jena AB, et al. Impact of Oral Nutrition Supplements on Hospital Outcomes in Pediatric Patients. J Parenter Enter Nutr. 2014;38(2_suppl):42S-49S. doi:10.1177/0148607114549769 Abdelhadi RA, Bouma S, Bairdain S, et al. Characteristics of Hospitalized Children With a Diagnosis

  • f Malnutrition. J Parenter Enter Nutr. 2016;40(5):623-635. doi:10.1177/0148607116633800

Carvalho-Salemi J, Salemi JL, Wong-Vega MR, et al. Malnutrition among Hospitalized Children in the United States: Changing Prevalence, Clinical Correlates, and Practice Patterns between 2002 and 2011. J Acad Nutr Diet. 2018;118(1):40-51.e7. doi:10.1016/j.jand.2017.02.015 Somanchi M, Tao X, Mullin GE. The Facilitated Early Enteral and Dietary Management Effectiveness Trial in Hospitalized Patients With Malnutrition. J Parenter Enter Nutr. 2011;35(2):209-216. doi:10.1177/0148607110392234 Agarwal E, Ferguson M, Banks M, et al. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010. Clin Nutr. 2013;32(5):737-745. doi:10.1016/J.CLNU.2012.11.021 Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31(3):345-350. doi:10.1016/J.CLNU.2011.11.001 Keller H, Allard JP, Laporte M, et al. Predictors of dietitian consult on medical and surgical wards. Clin Nutr. 2015;34(6):1141-1145. doi:10.1016/J.CLNU.2014.11.011

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References

Raslan M, Gonzalez MC, Torrinhas RSMM, Ravacci GR, Pereira JCR, Waitzberg DL. Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clin Nutr. 2011;30(1):49-53. doi:10.1016/J.CLNU.2010.07.002 Philipson T, Snider J, Lakdawalla, DN Stryckman B, Goldman B. Impact of oral nutritional supplementation on hospital outcomes. Am J Manag Care. 2013;19(2):121-128. Becker PJ, Nieman Carney L, Corkins MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). J Acad Nutr Diet. 2014;114(12):1988-2000. doi:10.1016/j.jand.2014.08.026 White J V, Guenter P, Jensen G, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet. 2012;112(5):730-738. doi:10.1016/j.jand.2012.03.012 Hand RK, Jordan B, DeHoog S, Pavlinac J, Abram JK, Parrott JS. Inpatient Staffing Needs for Registered Dietitian Nutritionists in 21st Century Acute Care Facilities. J Acad Nutr Diet. 2015;115(6):985-1000. doi:10.1016/J.JAND.2015.01.013 Phillips W. Clinical nutrition staffing benchmarks for acute care hospitals. J Acad Nutr Diet. 2015;115(7):1054-1056. doi:10.1016/j.jand.2015.03.020 Corkins MR, Guenter P, DiMaria-Ghalili RA, et al. Malnutrition Diagnoses in Hospitalized Patients. J Parenter Enter Nutr. 2014;38(2):186-195. doi:10.1177/0148607113512154

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Study Aims Assess the interrater reliability of the MCC. Determine the predictive validity of the adult and pediatric MCC relative to a portfolio of patient medical outcomes. Determine the relationship between the adult and pediatric MCC and body composition measurements conducted via bioelectrical impedance analysis (BIA) in a subset of patients.

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Study Aims

Identify the utility of BIA for body composition analysis in clinical settings. Estimate the level of RDN care necessary to improve patient

  • utcomes within the portfolio of outcomes. Specifically:

quantify the dose (minutes of care and frequency of encounters) of RDN care that is associated with improved medical outcomes in patients already identified as requiring nutrition care, after adjusting for disease severity and other potential confounders. Identify the additional level of RDN care necessary to improve the medical outcomes in patients who have been identified as malnourished using the MCC.

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