Abstract
Keywords
International Confederation of Dietetic Associations. 2010. http://www.internationaldietetics.org/. Accessed April 10, 2012.
Methods
Patients
Study Design
Nutrition Care Process component | Manual-paper based system | Innovative electronic system |
---|---|---|
Nutrition assessment | ||
Anthropometry |
|
|
Medical history/medications, biochemistry, and clinical information |
|
|
Dietary intake data |
|
|
Nutrition diagnosis | ||
|
| |
Nutrition intervention | ||
|
| |
Nutrition monitoring and evaluation | ||
|
|
Caring For Australasians with Renal Impairment (CARI). Chronic kidney disease guidelines. 2006. http://www.kdigo.org/guidelinescompare/cari.html. Accessed April 10, 2012.
National Allied Health Casemix Committee. Health activity hierarchy version 1.1: An Australian standard describing the range of activities provided by health professionals. 2001. http://www.nahcc.org.au/pdfs/hah.pdf. Accessed April 10, 2012.
Statistical Analysis
Results
Study Population
Nutrition-Related Diagnosis
Outcome parameter | Paper-Based Standard Care (Months 1-6) (n=56) | Electronic System (Months 7-12) (n=56) | ||||||
---|---|---|---|---|---|---|---|---|
Diagnosis Made | Resolution Achieved | Diagnosis Made | Resolution Achieved | |||||
n | % | n | % | n | % | n | % | |
Nutrition diagnostic codes | ||||||||
Intake domain | ||||||||
NI-3.2: Excessive fluid intake | 21 | 38 | 2 | 10 | 29 | 52 | 12 | 21 |
NI-5.1: Increased nutrient needs (energy/protein) | 4 | 7 | 1 | 25 | 4 | 7 | 1 | 25 |
NI-5.2: Malnutrition | 6 | 11 | 2 | 33 | 4 | 7 | 1 | 25 |
NI-5.3: Inadequate protein-energy | 15 | 27 | 8 | 53 | 9 | 16 | 6 | 67 |
NI-5.7.1: Inadequate protein | 14 | 25 | 3 | 21 | 16 | 29 | 5 | 31 |
NI-5.10.2.5: Excessive potassium intake | 13 | 23 | 4 | 31 | 18 | 32 | 10 | 56 |
NI-5.10.2.6: Excessive phosphate intake | 10 | 18 | 2 | 20 | 9 | 16 | 6 | 67 |
NI-5.10.2.7: Excessive sodium intake | 25 | 45 | 3 | 12 | 29 | 52 | 6 | 21 |
Clinical domain | ||||||||
NC-2.2: Altered nutrition-related laboratory value (phosphate) | 40 | 71 | 9 | 23 | 41 | 73 | 20 | 49 |
NC-3.1: Underweight | 7 | 13 | 0 | 0 | 6 | 11 | 0 | 0 |
NC- 3.3: Overweight/obesity | 13 | 23 | 0 | 0 | 13 | 23 | 0 | 0 |
Behavioral- environmental domain | ||||||||
NB-1.1: Food-and nutrition-related knowledge deficit | 3 | 5 | 1 | 33 | 6 | 11 | 4 | 67 |
Nutrition Interventions and Monitoring and Evaluation
Clinical Outcomes
Outcome parameter | Baseline | Paper-based (Months 1-6) | Electronic (Months 7-12) | P value |
---|---|---|---|---|
No. of diagnoses resolved, mean±standard deviation | — | 0.7±0.8 | 1.5±1.0 | <0.001 |
Nutritional status | ||||
Subjective global assessment B (mild to moderate)/C (severe), % (n) | 9 (5) | 8.5 (3) | 6.0 (3) | 1.00 |
Patient-generated subjective global assessment score, median (range) | 1 (0-13) | 1 (0-14) | 1 (0-9) | 0.094 |
Anthropometry | ||||
Body mass index, mean±standard deviation | 26.0±5.2 | 25.7±5.2 | 25.8±5.2 | 0.695 |
6-mo dry weight change (kg), mean %±standard deviation | — | −1.0±3.6 | 0.6±3.8 | 0.280 |
Interdialytic weight gain (kg), mean±standard deviation | 2.7±1.3 | 2.6±1.1 | 2.9±1.0 | 0.972 |
Biochemistry | ||||
Phosphate (mmol/L), mean±standard deviation | 1.8±0.5 | 1.8±0.5 | 1.8±0.6 | 0.513 |
Phosphate ≤1.6 mmol/L, % (n) | 36 (20) | 25 (14) | 39 (22) | 0.074 |
Potassium (mmol/L), mean±standard deviation | 4.7±0.7 | 4.7±0.7 | 5.0±0.7 | 0.999 |
Potassium ≤5.5 mmol/L, % (n) | 86 (48) | 79 (44) | 72 (46) | 0.875 |
Dietary intake, mean±standard deviation | ||||
Energy intake, kj/kg body weight | 109±25 | 113±35 | 115±28 | 0.827 |
Protein intake, g/kg body weight | 1.1±0.43 | 1.2±0.4 | 1.2±0.3 | 0.693 |
Quality of life | ||||
Mobility, % (n) | 30 (17) | 30 (17) | 36 (20) | 0.508 |
Self-care, % (n) | 13 (7) | 13 (7) | 13 (7) | 1.00 |
Usual activity, % (n) | 39 (22) | 39 (22) | 34 (19) | 0.581 |
Pain/discomfort, % (n) | 50 (28) | 50 (28) | 38 (21) | 0.039 |
Anxiety/depression, % (n) | 16 (9) | 14 (8) | 18 (13) | 0.180 |
Visual analogue scale score, mean±standard deviation | 68±22 | 72±21 | 73±19 | 0.900 |
EuroQol EQ-5D index score, mean±standard deviation | 0.75±0.30 | 0.74±0.32 | 0.77±0.29 | 0.433 |
Cost Outcomes
Discussion
DietitianPay.com. Renal dietitian salary information. 2012. http://dietitianpay.com/1/1/salary/Renal-Dietitian-Salary. Accessed August 3, 2012.
Conclusions
References
- A standardized nutrition care process and language are essential components of a conceptual model to guide and document nutrition care and patient outcomes.J Am Diet Assoc. 2004; 104: 1878-1884
- Nutrition Care Process and Model: ADA adopts road map to quality care and outcomes management.J Am Diet Assoc. 2003; 103: 1061-1072
International Confederation of Dietetic Associations. 2010. http://www.internationaldietetics.org/. Accessed April 10, 2012.
- Implementation and practical application of the nutrition care process in the dialysis unit.J Renal Nutr. 2013; 23: 65-73
- Successes in Implementing the Nutrition Care Process and Standardized Language In Clinical Practice.J Am Diet Assoc. 2008; 108: A42
- Implementing nutrition diagnosis at a multisite health care organization.Can J Diet Pract Res. 2011; 72: 178-180
- Using the standardized language for the Nutrition Care Process in the electronic health record to measure and report nutrition care outcomes.J Am Diet Assoc. 2010; 110: A86
- Implementation and evaluation of outcomes related to the Nutrition Care Process through the use of electronic health records.J Am Diet Assoc. 2010; 110: A86
- A review on systematic reviews of health information system studies.J Am Med Inform Assoc. 2010; 17: 637-645
- Nutritional status in dialysis patients: A European consensus.Nephrol Dial Transplant. 2002; 17: 563-572
- American Dietetic Association and the National Kidney Foundation Standards of Practice and Standards of Professional Performance for registered dietitians (generalist, specialty, and advanced) in nephrology care.J Ren Nutr. 2009; 19: 345-356
- Trial of an allied health workload allocation model.Aust Health Rev. 2011; 35: 168-175
- Patient-generated subjective global assessment.in: McCallum P.D. Polisena C.G. The Clinical Guide to Oncology Nutrition. American Dietetic Association, Chicago, IL2000
- Assessment of nutritional status in hemodialysis patients using patient-generated subjective global assessment.J Ren Nutr. 2005; 15: 211-216
- Accuracy of dietary recall using the USDA five-step multiple-pass method in men: An observational validation study.J Am Diet Assoc. 2004; 104: 595-603
- Evidence based practice guidelines for the nutritional management of chronic kidney disease.Nutr Diet. 2006; 63: S33-S45
- International Dietetics and Nutritional Terminology (IDNT) Reference Manual. 3rd ed. American Dietetic Association, Chicago, IL2010
Caring For Australasians with Renal Impairment (CARI). Chronic kidney disease guidelines. 2006. http://www.kdigo.org/guidelinescompare/cari.html. Accessed April 10, 2012.
- Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee.Am J Hum Biol. 1996; 8: 786-787
National Allied Health Casemix Committee. Health activity hierarchy version 1.1: An Australian standard describing the range of activities provided by health professionals. 2001. http://www.nahcc.org.au/pdfs/hah.pdf. Accessed April 10, 2012.
- Szende A. Oppe M. Devlin N.E. EQ-5D Value Sets: Inventory, Comparative Review and User Guide. Springer, Dordrecht, the Netherlands2007
DietitianPay.com. Renal dietitian salary information. 2012. http://dietitianpay.com/1/1/salary/Renal-Dietitian-Salary. Accessed August 3, 2012.
- Staff knowledge, confidence and perceptions prior to implementation of the Nutrition Care Process (NCP) and International Dietetics and Nutrition Terminology (IDNT).J Acad Nutr Diet. 2011; 111: A73
Biography
Article info
Publication history
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was funded by the Queensland Health-Health Practitioner Research Scheme. K. L. Campbell is a current recipient of a Queensland Government Health Research Fellowship and Lions Senior Medical Research Fellowship.