Caring Futures Institute, College of Nursing and Health Sciences, GPO Box 2100, Adelaide, 5001, Australia.
College of Nursing and Health Sciences, GPO Box 2100, Adelaide, 5001, Australia.
BMC Health Serv Res. 2021 Nov 30;21(1):1288. doi: 10.1186/s12913-021-07299-y.
To improve nutritional assessment and care pathways in the acute care setting, it is important to understand the indicators that may predict nutritional risk. Informed by a review of systematic reviews, this project engaged stakeholders to prioritise and reach consensus on a list of evidence based and clinically contextualised indicators for identifying malnutrition risk in the acute care setting.
A modified Delphi approach was employed which consisted of four rounds of consultation with 54 stakeholders and 10 experts to reach consensus and refine a list of 57 risk indicators identified from a review of systematic reviews. Weighted mean and variance scores for each indicator were evaluated. Consistency was tested with intra class correlation coefficient. Cronbach's alpha was used to determine the reliability of the indicators. The final list of indicators was subject to Cronbach's alpha and exploratory principal component analysis.
Fifteen indicators were considered to be the most important in identifying nutritional risk. These included difficulty self-feeding, polypharmacy, surgery and impaired gastro-intestinal function. There was 82% agreement for the final 15 indicators that they collectively would predict malnutrition risk in hospital inpatients.
The 15 indicators identified are supported by evidence and are clinically informed. This represents an opportunity for translation into a novel and automated systems level approach for identifying malnutrition risk in the acute care setting.
为了改善急性护理环境中的营养评估和护理路径，了解可能预测营养风险的指标非常重要。本项目在系统评价综述的基础上，征求利益相关者的意见，对确定急性护理环境中营养不良风险的基于证据和临床相关指标进行优先级排序并达成共识。
采用改良 Delphi 法，对 54 名利益相关者和 10 名专家进行四轮咨询，以达成共识并完善从系统评价综述中确定的 57 个风险指标清单。对每个指标的加权均值和方差得分进行评估。采用组内相关系数检验一致性。使用克朗巴赫α检验指标的可靠性。最后，对指标清单进行克朗巴赫α和探索性主成分分析。
有 15 个指标被认为是识别营养风险的最重要指标。这些指标包括自行进食困难、多种药物治疗、手术和胃肠功能受损。最终有 15 个指标的一致性达到 82%，这些指标共同预测住院患者的营养不良风险。
确定的 15 个指标具有证据支持且临床意义明确。这为在急性护理环境中开发一种新颖的、自动化的系统水平方法来识别营养不良风险提供了机会。
