Chaney Amanda J, Heckman Michael G
1 Department of Transplant Medicine, Mayo Clinic, Jacksonville, FL, USA.
2 Division of Biomedical Statistics and Informatics. Mayo Clinic, Jacksonville, FL, USA.
Prog Transplant. 2018 Dec;28(4):390-393. doi: 10.1177/1526924818800052. Epub 2018 Sep 24.
Nutritional interventions improve patient outcomes and reduce mortality in patients with cirrhosis by reducing infection risk, ascites, length of stay in hospital and intensive care unit, and mortality. Follow-up phone calls have been found to be useful in improving patient adherence to therapy.
The purpose of this quality improvement project was to determine whether supplemental nutrition education would improve nutrition and outcomes among patients with cirrhosis who are undergoing a liver transplant evaluation. In addition, we sought to measure patient adherence with nutritional recommendations and whether patients perceived this additional education improved their nutrition status.
The Plan-Do-Study-Ask methodology was used.
Addressed 8 patients were enrolled to participate in the supplemental nutrition education, after which they received 3 follow-up phone calls. A retrospective review of data from 10 patients meeting project inclusion criteria were identified by the nutrition specialist and were used as a comparison group. Data were analyzed using descriptive statistics; comparing data from before and after implementation of the supplemental nutrition education was done.
At the end of the 8-week project period, 4 (66.7%) patients reported weight loss since the time of enrollment (nutrition education class), and the median patient-generated subjective global assessment score increased by 4 points, rather than decreasing as expected. However, all patients reported they believed the phone calls improved their nutrition status.
With a multidisciplinary approach, this additional patient education may improve patient care and outcomes.
营养干预可通过降低感染风险、腹水、住院及重症监护病房的住院时间以及死亡率，改善肝硬化患者的预后并降低死亡率。已发现随访电话有助于提高患者对治疗的依从性。
本质量改进项目的目的是确定补充营养教育是否会改善正在接受肝移植评估的肝硬化患者的营养状况和预后。此外，我们试图衡量患者对营养建议的依从性，以及患者是否认为这种额外的教育改善了他们的营养状况。
采用计划-实施-研究-询问方法。
招募了8名符合条件的患者参加补充营养教育，之后他们接受了3次随访电话。营养专家确定了10名符合项目纳入标准的患者的数据进行回顾性分析，并将其作为对照组。使用描述性统计分析数据；对补充营养教育实施前后的数据进行了比较。
在为期8周的项目结束时，4名（66.7%）患者报告自入组（营养教育课程）以来体重减轻，患者自行生成的主观全面评定分数中位数增加了4分，而不是像预期的那样下降。然而，所有患者都报告他们认为这些电话改善了他们的营养状况。
通过多学科方法，这种额外的患者教育可能会改善患者护理和预后。
