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More-2-Eat: Evaluation protocol of a multi-site implementation of the Integrated Nutrition Pathway for Acute Care


Type

Article

Change log

Authors

Laur, C 
Valaitis, R 
Bell, J 
McNicholl, T 

Abstract

Abstract

            Background
            Nutrition care in hospitals is often haphazard, and malnourished patients are not always readily identified and do not receive the care they require. The Integrated Nutrition Pathway for Acute Care (INPAC) is an algorithm designed to improve the prevention, detection and treatment of malnutrition in medical and surgical patients. More-2-Eat is an evaluation of the implementation of INPAC care activities (e.g. screening) in five diverse medical units from different hospitals in Canada. The primary purpose is to understand how tailored implementation affects INPAC uptake and factors that impact this implementation. The principal outcome is a toolkit that can provide guidance to others.
          
          
            Methods
            This participatory action research uses a before-after time series design to address several research questions focused on implementation and uptake of INPAC (e.g., Does the implementation of INPAC improve the detection of malnutrition? Do nutrition care related knowledge, attitudes and practices scores of unit staff change with the implementation of INPAC?). A six-month developmental phase where baseline data were collected is followed by a twelve-month implementation phase and a three-month sustainability phase. Qualitative and quantitative data are collected concurrently, and to address key research questions, these data are merged. Quantitative data are collected on-site by trained local dietitians and include chart audits of nutrition care practices and a more detailed assessment of recruited patients on quality of life, disability, frailty, food intake and barriers to food intake. Thirty-day post discharge follow up for these patients occurs by researchers via a telephone interview at three time points within baseline and implementation phases, to ascertain the same and other outcomes (e.g. readmission to hospital). Qualitative data include focus groups and key informant interviews completed by researchers, monthly teleconferences among the sites and site-completed forms that track implementation activities. Resource utilization of dietitian time for various care activities (e.g. assessment) and staff time to assist patients at mealtimes is also collected.
          
          
            Discussion
            More-2-Eat provides an example of how implementation can be tailored when a care algorithm is embedded into routine practice. The project also highlights important learning points with respect to data collection and techniques to support implementation.
          
          
            Trial registration
            Retrospectively registered ClinTrials.gov Identifier: 
                NCT02800304
                
               June 7, 2016.

Description

Keywords

32 Biomedical and Clinical Sciences, 3210 Nutrition and Dietetics, Clinical Research, Health Services, Nutrition, Behavioral and Social Science, Prevention, 8 Health and social care services research, 8.1 Organisation and delivery of services, Generic health relevance, 2 Zero Hunger

Journal Title

BMC Nutrition

Conference Name

Journal ISSN

2055-0928
2055-0928

Volume Title

Publisher

Springer Science and Business Media LLC