Abstract
In this article, we evaluate relationships between Nutrition Care Process (NCP) chain
links and improvement or resolution of the nutrition diagnosis. We conducted a retrospective
record review for 12 months in a single Veterans Health Administration health care
system using the Veterans Health Administration–specific monitoring and evaluation
terms, NCP terminology, and its etiology categories to evaluate outcomes. Logistic
regression analysis revealed that the strongest predictor for diagnosis improvement
was the etiology–intervention link. The odds of improving the nutrition diagnosis
were 51.43 times higher when the etiology–intervention link was present. The odds
of improving the nutrition diagnosis were 19.74 times higher when the evidence–diagnosis
link was present and 9.46 times higher when the intervention–goal link was present.
For every added nutrition visit by the registered dietitian nutritionist, the odds
of improving the nutrition diagnosis increased by 32.5%. For every increased point
on the NCP audit score, the odds of resolving or improving the nutrition diagnosis
increased by 37.7%. When applying the NCP, the presence of the etiology–intervention
link significantly improves the odds of resolving the nutrition diagnosis in a Veterans
Health Administration population. For the first time, we show evidence that the NCP
works as designed. Also, we demonstrate that the quality of NCP documentation impacts
resolution of the diagnosis, and we describe the methodology for how to evaluate NCP
outcomes. Registered dietitian nutritionists are encouraged to critically evaluate
links of the NCP chain, assess NCP documentation for quality, and pursue follow-up
visits to improve resolution of nutrition problems.
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References
- Nutrition care process and model: ADA adopts road map to quality care and outcomes management.J Am Diet Assoc. 2003; 103: 1061-1072
- Nutrition care process and model update: Toward realizing people-centered care and outcomes management.J Acad Nutr Diet. 2017; 117: 2003-2014
- Nutrition care process. About eNCPT.(Updated 2018. Accessed January 30, 2020)
- Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII): A pilot study on the documentation of the nutrition care process and the usability of ANDHII by registered dietitian nutritionists.J Acad Nutr Diet. 2018; 118: 1966-1974
- 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
- Clinical reasoning model: A clinical inquiry guide for solving problems in the nursing domain.in: Lyon B.L. Foundations of Clinical Nurse Specialist Practice. Springer Publishing, New York, NY2014: 65-81
- Evaluating interventions.in: Lyon B.L. Foundations of Clinical Nurse Specialist Practice. Springer Publishing, New York, NY2014: 97-108
- Standardizing patient outcomes measurement.N Engl J Med. 2016; 374: 504-506
- Nutrition care process chains: The "missing link" between research and evidence-based practice.J Acad Nutr Diet. 2015; 115: 1491-1498
- (Updated 2017. Accessed June 2, 2019)
- Nutrition care process (NCP) update part 2: Developing and using the NCP terminology to demonstrate efficacy of nutrition care and related outcomes.J Acad Nutr Diet. 2019; 119: 840-855
- Orientation to nutrition care process standards improves nutrition care documentation by nutrition practitioners.J Am Diet Assoc. 2005; 105: 1582-1589
Event Capture System Veterans Health information Systems and Technology Architecture Class I workload reporting system. Version 2.0. Washington, DC: Department of Veterans Affairs Managerial Cost Accounting Office; 2019.
- Nutrition care process implementation: Experiences in various dietetics environments in Sweden.J Acad Nutr Diet. 2017; 117: 1738-1748
- SPSS for Windows [computer program]. Version 25. SPSS Inc, Chicago, IL2017
- State/territories summary report.(Published 2017. Accessed January 30, 2020)
- VA/DOD clinical practice guidelines: Management of obesity and overweight.(Published 2014. Accessed January 30, 2020)
- The obesity epidemic in the Veterans Health Administration: Prevalence among key populations of women and men veterans.J Gen Intern Med. 2017; 32: 11-17
- 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
- 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
- Reliability, validity, sensitivity and usefulness testing of dietetic specific monitoring and evaluation indicators and measurement scales.J Acad Nutr Diet. 2012; 112 (A-63)
- Predictors of weight reduction and maintenance in a large cohort of overweight and obese adults in a community setting.Nutr Diet. 2018; 75: 390-396
- Clinical and cost benefits of medical nutrition therapy by registered dietitian nutritionists for management of dyslipidemia: A systematic review and meta-analysis.J Clin Lipidol. 2018; 12: 1113-1122
- Clinical documentation in the 21st century: Executive summary of a policy position paper from the American College of Physicians.Ann Intern Med. 2015; 162: 301-303
- Standardized nomenclatures: Keys to continuity of care, nursing accountability and nursing effectiveness.Outcomes Manag Nurs Pract. 1998; 2: 81-86
- Consensus recommendations for optimizing electronic health records for nutrition care.J Acad Nutr Diet. 2020; 120: 1227-1237
- A nutrition care process audit of the national quality improvement dataset: Supporting the improvement of data quality using the ANDHII platform.J Acad Nutr Diet. 2020; 120: 1238-1248.e1
- Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States.JAMA Surg. 2013; 148: 1095-1102
- Rehospitalization to primary versus different facilities following abdominal aortic aneurysm repair.J Vasc Surg. 2014; 59 (1510.e1-e2): 1502-1510
- HL7 CDA R2 Implementation Guide: C-CDA R2.1 Supplemental Templates for Nutrition, Release 1–US Realm [computer program]. Health Level Seven International, Ann Arbor, MI2019
Biography
S. L. Lewis is internship director for the Anne Brezina Dietetic Internship Program at the James A. Haley Veterans Hospitals and Clinics in Tampa, FL; at the time of the study, she was a graduate student, University of North Florida, Jacksonville.
Biography
L. Wright is chair, Department of Nutrition and Dietetics, University of North Florida, Jacksonville.
Biography
A. Y. Arikawa is associate professor, Department of Nutrition and Dietetics, University of North Florida, Jacksonville.
Biography
C. Papoutsakis is senior director, Data Science Center, International and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL.
Article Info
Publication History
Published online: July 28, 2020
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST C. Papoutsakis is an employee of the Academy of Nutrition and Dietetics, which has a financial interest in the Nutrition Care Process terminology described here. No potential conflict of interest was reported by the other authors.
Identification
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© 2021 by the Academy of Nutrition and Dietetics.
