Etiology Intervention Link Predicts Resolution of Nutrition Diagnosis: A Nutrition Care Process Outcomes Study from a Veterans’ Health Care Facility


      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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      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.


      L. Wright is chair, Department of Nutrition and Dietetics, University of North Florida, Jacksonville.


      A. Y. Arikawa is associate professor, Department of Nutrition and Dietetics, University of North Florida, Jacksonville.


      C. Papoutsakis is senior director, Data Science Center, International and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL.