Keller Heather H, Xu Yingying, Dubin Joel A, Curtis Lori, Laur Celia V, Bell Jack
University of Waterloo, 200 University Ave W., Waterloo, ON, N2L3G1, Canada; Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada.
University of Waterloo, 200 University Ave W., Waterloo, ON, N2L3G1, Canada.
Clin Nutr ESPEN. 2018 Dec;28:74-79. doi: 10.1016/j.clnesp.2018.09.075. Epub 2018 Oct 11.
Poor food intake is common in hospital patients and is associated with adverse patient and healthcare outcomes; diverse mealtime barriers to intake often undermine clinical nutrition care.
This study determines whether implementation of locally adaptable nutrition care activities as part of uptake of the Integrated Nutrition Pathway for Acute Care (INPAC) reduced mealtime barriers and improved other patient outcomes (e.g. length of stay; LOS) when considering other covariates.
1250 medical patients from 5 Canadian hospitals were recruited for this before-after time series design. Mealtime barriers were tallied with the Mealtime Audit Tool after a meal, while proportion of the meal consumed was assessed with the My Meal Intake Tool. Implementation of new standard care activities occurred over 12 months and three periods (pre-, early, and late) of implementation were compared. Regression analyses determined the effect of time period while adjusting for key covariates.
Mealtime barriers were reduced over time periods (Period 1 = 2.5 S.D. 2.1; Period 3 = 1.8 S.D. 1.7) and site differences were noted. This decrease was statistically significant in regression analyses (-0.28 per time period; 95% CI -0.44, -0.11). Within and across site changes were also observed over time in meal intake and LOS; however, after adjusting for covariates, time period of implementation was not significantly associated with these outcomes.
Mealtime barriers can be reduced and sustained by implementing improved standard care procedures for patients. The More-2-Eat study provides an example of how to implement changes in practice to support the prevention and treatment of malnutrition.
Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016.
住院患者中食物摄入量低的情况很常见，且与不良的患者和医疗保健结果相关；进餐时的各种障碍常常会破坏临床营养护理。
本研究旨在确定作为急性护理综合营养途径（INPAC）实施内容一部分的因地制宜的营养护理活动，在考虑其他协变量时，是否能减少进餐障碍并改善其他患者结局（如住院时间；LOS）。
采用前后时间序列设计，招募了来自加拿大5家医院的1250名内科患者。用餐后使用用餐审核工具统计进餐障碍，同时使用我的进餐摄入量工具评估进餐量的比例。新的标准护理活动在12个月内实施，并比较了实施的三个阶段（前期、早期和后期）。回归分析确定了时间段的影响，同时对关键协变量进行了调整。
随着时间推移，进餐障碍有所减少（第1阶段=2.5标准差2.1；第3阶段=1.8标准差1.7），且存在地点差异。在回归分析中，这种减少具有统计学意义（每个时间段-0.28；95%置信区间-0.44，-0.11）。随着时间的推移，在进餐量和住院时间方面也观察到了地点内部和地点之间的变化；然而，在调整协变量后，实施时间段与这些结局并无显著关联。
通过为患者实施改进的标准护理程序，可以减少并持续降低进餐障碍。“多吃一点”研究提供了一个如何在实践中实施变革以支持营养不良预防和治疗的例子。
回顾性注册，ClinicalTrials.gov标识符：NCT02800304，2016年6月7日。
