Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany.
Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany.
Clin Nutr ESPEN. 2023 Oct;57:246-252. doi: 10.1016/j.clnesp.2023.06.029. Epub 2023 Jun 29.
BACKGROUND & AIMS: Early identification of patients at risk for malnutrition followed by individualized nutrition interventions is a central step to the provision of appropriate nutrition care. However, a health care professional (HCP)-based nutrition screening is not always consistently integrated into routine care. Patient-reported (PR) nutrition screening could thus potentially alleviate the burden on the HCPs and contribute to a greater number of patients who are identified and treated for malnutrition.
In 2021 a Quality Improvement Project (QIP) at our out-patient oncology clinic was undertaken to implement the change from a HCP-based nutrition screening to a PR-screening. This was followed by a retrospective analysis in which the primary outcome measure was the rate of nutrition consultations initiated for patients undergoing cancer therapy.
In total n = 1657 patient data sets derived from comparable time periods before and after the QIP were analyzed and compared. Both groups had a comparable mean age and gender distribution. The most common diagnosis in both groups was gastrointestinal tumors. The change in routine care from a HCP-based nutrition screening to a PR-screening led to a significant increase in nutrition consultation rates (RD = 19%; p < 0.001; 95% CI 14.4%-23.5%) and screening rates (RD = 30.5%; p < 0.001; 95% CI 26.2%-34.7%).
The change to PR-screening potentially facilitates an increase in nutrition screening rates. This in turn leads to an increased rate of patients identified at risk for malnutrition and thus referrals for nutrition consultations. Our findings indicate that a PR nutrition screening tool could play a role in closing the care gap and contribute to reducing rates of malnutrition among this population where screening is not consistently integrated into routine care.
对存在营养不良风险的患者进行早期识别,然后实施个体化营养干预,这是提供恰当营养护理的关键步骤。然而,医疗保健专业人员(HCP)进行的营养筛查并不总是能持续纳入常规护理。因此,患者报告(PR)营养筛查可能会减轻 HCP 的负担,并有助于更多的患者被识别和治疗营养不良。
2021 年,我们的门诊肿瘤诊所开展了一项质量改进项目(QIP),将营养筛查从 HCP 主导改为 PR 主导。随后进行了回顾性分析,主要结局指标是接受癌症治疗的患者开始营养咨询的比例。
共分析比较了 QIP 前后可比时间段的 1657 例患者数据集。两组的平均年龄和性别分布相似。两组最常见的诊断均为胃肠道肿瘤。常规护理从 HCP 主导的营养筛查改为 PR 筛查,导致营养咨询率(RD=19%;p<0.001;95%CI 14.4%-23.5%)和筛查率(RD=30.5%;p<0.001;95%CI 26.2%-34.7%)显著增加。
改为 PR 筛查可能有助于提高营养筛查率。这反过来又会增加识别存在营养不良风险的患者的比例,并因此增加营养咨询的比例。我们的研究结果表明,患者报告的营养筛查工具可以在缩小护理差距方面发挥作用,并有助于降低该人群的营养不良发生率,因为在常规护理中并未持续纳入筛查。