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Comparison of Nutrition Diagnosis Resolution Rates before and after Electronic Health Record Implementation
SUNDAY, OCTOBER 20
Research & Practice Innovations: Implementation of the Nutrition Care Process and Health Outcome Measures Assessing Practices and Perceptions of Board Certified Specialists in Pediatric Nutrition about the Nutrition Care Process/International Dietetics and Nutrition Terminology Author(s): M. Auslander, E.B. Enrione; Department of Dietetics & Nutrition, Florida Intl. Univ., Miami, FL Learning Outcome: The participant will be able to identify perceptions and describe practices of Board Certified Specialists in Pediatric Nutrition related to the Nutrition Care Process/International Dietetics and Nutrition Terminology. Registered Dietitians, Board Certified Specialists in Pediatric Nutrition (RD CSPs) may or may not be applying the Nutrition Care Process (NCP)/International Dietetics and Nutrition Terminology (IDNT) in practice. This study investigated RD CSPs’ practices and perceptions regarding NCP/IDNT. A survey was emailed to 638 CSPs. Chi-square tests analyzed differences between practicing and not practicing with NCP/ IDNT by geographic regions, education, and practice settings. Of those who responded (37.9%, n¼239), 76.2% (n¼182) reported practicing with NCP. Although 68.4% (n¼162) used IDNT, over half (60.2%, n¼ 139) “rarely” and “never” referred to the IDNT manual. While 45.5% (n¼106) “always” applied NCP's steps, 45.5% (n¼76) “always” used IDNT for the steps. These RDs found “time to complete process/ documentation” and “not appropriate for pediatrics” most challenging with NCP/IDNT (63.1%, n¼147, 75.4%, n¼172; 71.2%, n¼166, 78.5%, n¼179, respectively). Only 27.2% (n¼62) agreed NCP improves patient care and 40.7% (n¼93) agreed it promotes the profession. The northeast (47.4%) had a significantly smaller percentage of CSPs apply NCP than the midwest (79.4%), south (83.8%), and west (67.9%) (3, N¼237)¼14.28, P¼0.003. Significantly higher percentages of inpatient (81.5%) and outpatient (74.7%) acute care CSPs practiced with NCP than those in “other” practice settings (55.2%) (2, N¼239)¼9.23, P¼0.01. Disproportionate use appears nationally and among practice settings. Although CSPs applied NCP, they avoided referencing the IDNT manual and perceived the standardized language as challenging for pediatrics. The concept of NCP benefiting patients and the profession was not supported. Terminology and perceptions of NCP/IDNT seem to hinder comprehensive application.
Subjective Global Assessment Scores Are Not Valid Among the Obese Hemodialysis Population: A Secondary Study Author(s): E.D. Erb1, R.K. Hand2, A.L. Steiber2; 1Nutrition, Case Western Reserve Univ., Cleveland, OH, 2Academy of Nutrition and Dietetics, Chicago, IL Learning Outcome: Describe how the relationship between SGA and serum albumin varies between obese and non-obese hemodialysis patients. Background: The subjective global assessment (SGA) is a validated nutrition assessment tool used by researchers, clinicians, and dietitians. The validity of the SGA has not been established in the obese hemodialysis (HD) population. Methods: This secondary analysis of data from the Subjective Global Assessment Validation Project and Nutrition Algorithm Preliminary Report determined the validity of the 7-point SGA in the obese HD population by comparing SGA scores to albumin, used as the gold standard for this analysis. Data were analyzed from a combined sample of 253 HD patients. Results: The 253 patients were categorized into well-nourished (68%, SGA score 6-7; WN) and malnourished (score 1-5; MN) groups, and, based on BMI, into obese > 32 (28%) and non-obese < 32. Mean baseline data ( SD) were: age, 63.5 14.3 years; BMI, 29 8 kg/m2; and serum albumin 3.8 0.4 mg/ dL (bromocresol green). Obese and non-obese populations had statistically significant differences in BMI (obese p < 0.6877, non-obese p < 0.0005) and serum albumin values (obese p < 0.5221, non-obese p < 0.0052) between WN and MN groups by ANOVA. A multivariable ordinal logistic fit was used to predict SGA group with age and gender as covariates. While serum albumin (p < 0.0049) and BMI < 32 (p < 0.0063) predicted SGA group, BMI > 32 (p < 0.5337) did not. Conclusion: This secondary analysis showed that the SGA is not a valid nutrition assessment tool among the obese HD population when compared to serum albumin. Funding Disclosure: None for secondary analysis; primary studies were funded by grants from Genzyme, The Academy of Nutrition and Dietetics Foundation and the National Kidney Foundation
Funding Disclosure: None
Comparison of Nutrition Diagnosis Resolution Rates before and after Electronic Health Record Implementation
Content Validation of Two Nutrition Diagnoses Commonly Identified in Oncology Patients
Author(s): R. Shiner, S. Roberts; Baylor University Medical Center, Dallas, TX
Author(s): E.B. Enrione, J. Villar; Department of Dietetics & Nutrition, Florida Intl. Univ., Miami, FL
Learning Outcome: To compare nutrition diagnoses (ND) and ND resolution before and after implementation of an electronic health record at a large tertiary teaching hospital. Objective: To compare nutrition diagnoses (ND) and ND resolution before and after implementation of an electronic health record (EHR) at a large, tertiary teaching hospital. Methods: Prior to EHR implementation, the number of and resolution rates (RR) for ND were prospectively collected from the medical records of 300 patients for the time period of June 2009 to February 2011. Post-EHR, a report generated within minutes from the EHR for the time period of June 2012 to December 2012 was utilized to determine number of and ND RR as well as ND RR based on length of stay (LOS) of < 7 days or >14 days. Results: During the pre-EHR period, 632 ND were identified with a 30.7% RR (206/632). During the post-EHR period, 8336 ND were identified with a 30.4% RR (2534/8336). When patients had a LOS < 7 days, the ND RR was 12.1% while patients with a LOS > 14 days had an ND RR of 51.8%. The pre- and postEHR ND RR were similar for all patients. The post-EHR RR based on LOS demonstrate a low RR for individuals with a shorter LOS and a higher RR for those with a longer LOS. Conclusion: An EHR-generated report can be useful and more efficient way to gather a large amount of data regarding ND and corresponding RR. Registered Dietitians (RD) should take into account a patient's expected LOS and select ND that can realistically be resolved by RD interventions within the predicted LOS timeframe. Funding Disclosure: None
Learning Outcome: The participant will be able to assess the content validity of the definitions, etiologies and signs/symptoms for the diagnoses, Inadequate Oral Intake and Increased Nutrient Needs Content validation provides evidence that standardized language is accurate and occurs in practice. Few studies have investigated content validity of nutrition diagnoses. This study determined content validity of Inadequate Oral Intake (IOI) and Increased Nutrient Needs (INN), which have been diagnosed in oncology patients. Registered Dietitians, Board Certified Specialists in Oncology Nutrition (RD, CSOs) (n¼462) were emailed a Nutrition Diagnostic Validation Instrument. Participants rated components (definition, etiologies, and sign/symptoms) from 1¼not characteristic to 5¼very characteristic. Diagnostic content validity (DCV) and total DCV scores for components were calculated and classified as major (DCV0.80), minor (DCV<0.80 and >0.50) or not characteristic (DCV0.5). Pearson correlations were computed between scores and years as an RD, as a CSO, practicing oncology nutrition, and diagnosing nutrition problems. Those that responded (n¼165) were CSOs and practiced oncology nutrition an average 2.68 years (SD¼1.34) and 10.22 years (SD¼7.22), respectively. The majority diagnosed nutrition problems 3 years (58.8%, n¼101). Total DCV¼0.69 for IOI with one etiology not characteristic (DCV¼0.41). The other components’ DCV scores ranged from 0.54-0.90, the majority (73.7%, n¼14) minor. Total DCV¼0.74 for INN. The components’ DCV scores ranged from 0.58-0.89, the majority (77.3%, n¼22) minor. The INN's definition correlated significantly with RD tenure, r ¼ -.19, P<0.05, and years practicing oncology nutrition, r ¼ -.22, P<0.01. Those who were RDs and practiced oncology nutrition longer rated the INN's definition less characteristic. These CSOs were somewhat confident the diagnoses represented what occurs in practice. Refinement of the terminology may be warranted as many components were minor. Funding Disclosure: None
September 2013 Suppl 3—Abstracts Volume 113 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-13
Research & Practice Innovations: Implementation of the Nutrition Care Process and Health Outcome Measures Assessing Practices and Perceptions of Board Certified Specialists in Pediatric Nutrition about the Nutrition Care Process/International Dietetics and Nutrition Terminology Author(s): M. Auslander, E.B. Enrione; Department of Dietetics & Nutrition, Florida Intl. Univ., Miami, FL Learning Outcome: The participant will be able to identify perceptions and describe practices of Board Certified Specialists in Pediatric Nutrition related to the Nutrition Care Process/International Dietetics and Nutrition Terminology. Registered Dietitians, Board Certified Specialists in Pediatric Nutrition (RD CSPs) may or may not be applying the Nutrition Care Process (NCP)/International Dietetics and Nutrition Terminology (IDNT) in practice. This study investigated RD CSPs’ practices and perceptions regarding NCP/IDNT. A survey was emailed to 638 CSPs. Chi-square tests analyzed differences between practicing and not practicing with NCP/ IDNT by geographic regions, education, and practice settings. Of those who responded (37.9%, n¼239), 76.2% (n¼182) reported practicing with NCP. Although 68.4% (n¼162) used IDNT, over half (60.2%, n¼ 139) “rarely” and “never” referred to the IDNT manual. While 45.5% (n¼106) “always” applied NCP's steps, 45.5% (n¼76) “always” used IDNT for the steps. These RDs found “time to complete process/ documentation” and “not appropriate for pediatrics” most challenging with NCP/IDNT (63.1%, n¼147, 75.4%, n¼172; 71.2%, n¼166, 78.5%, n¼179, respectively). Only 27.2% (n¼62) agreed NCP improves patient care and 40.7% (n¼93) agreed it promotes the profession. The northeast (47.4%) had a significantly smaller percentage of CSPs apply NCP than the midwest (79.4%), south (83.8%), and west (67.9%) (3, N¼237)¼14.28, P¼0.003. Significantly higher percentages of inpatient (81.5%) and outpatient (74.7%) acute care CSPs practiced with NCP than those in “other” practice settings (55.2%) (2, N¼239)¼9.23, P¼0.01. Disproportionate use appears nationally and among practice settings. Although CSPs applied NCP, they avoided referencing the IDNT manual and perceived the standardized language as challenging for pediatrics. The concept of NCP benefiting patients and the profession was not supported. Terminology and perceptions of NCP/IDNT seem to hinder comprehensive application.
Subjective Global Assessment Scores Are Not Valid Among the Obese Hemodialysis Population: A Secondary Study Author(s): E.D. Erb1, R.K. Hand2, A.L. Steiber2; 1Nutrition, Case Western Reserve Univ., Cleveland, OH, 2Academy of Nutrition and Dietetics, Chicago, IL Learning Outcome: Describe how the relationship between SGA and serum albumin varies between obese and non-obese hemodialysis patients. Background: The subjective global assessment (SGA) is a validated nutrition assessment tool used by researchers, clinicians, and dietitians. The validity of the SGA has not been established in the obese hemodialysis (HD) population. Methods: This secondary analysis of data from the Subjective Global Assessment Validation Project and Nutrition Algorithm Preliminary Report determined the validity of the 7-point SGA in the obese HD population by comparing SGA scores to albumin, used as the gold standard for this analysis. Data were analyzed from a combined sample of 253 HD patients. Results: The 253 patients were categorized into well-nourished (68%, SGA score 6-7; WN) and malnourished (score 1-5; MN) groups, and, based on BMI, into obese > 32 (28%) and non-obese < 32. Mean baseline data ( SD) were: age, 63.5 14.3 years; BMI, 29 8 kg/m2; and serum albumin 3.8 0.4 mg/ dL (bromocresol green). Obese and non-obese populations had statistically significant differences in BMI (obese p < 0.6877, non-obese p < 0.0005) and serum albumin values (obese p < 0.5221, non-obese p < 0.0052) between WN and MN groups by ANOVA. A multivariable ordinal logistic fit was used to predict SGA group with age and gender as covariates. While serum albumin (p < 0.0049) and BMI < 32 (p < 0.0063) predicted SGA group, BMI > 32 (p < 0.5337) did not. Conclusion: This secondary analysis showed that the SGA is not a valid nutrition assessment tool among the obese HD population when compared to serum albumin. Funding Disclosure: None for secondary analysis; primary studies were funded by grants from Genzyme, The Academy of Nutrition and Dietetics Foundation and the National Kidney Foundation
Funding Disclosure: None
Comparison of Nutrition Diagnosis Resolution Rates before and after Electronic Health Record Implementation
Content Validation of Two Nutrition Diagnoses Commonly Identified in Oncology Patients
Author(s): R. Shiner, S. Roberts; Baylor University Medical Center, Dallas, TX
Author(s): E.B. Enrione, J. Villar; Department of Dietetics & Nutrition, Florida Intl. Univ., Miami, FL
Learning Outcome: To compare nutrition diagnoses (ND) and ND resolution before and after implementation of an electronic health record at a large tertiary teaching hospital. Objective: To compare nutrition diagnoses (ND) and ND resolution before and after implementation of an electronic health record (EHR) at a large, tertiary teaching hospital. Methods: Prior to EHR implementation, the number of and resolution rates (RR) for ND were prospectively collected from the medical records of 300 patients for the time period of June 2009 to February 2011. Post-EHR, a report generated within minutes from the EHR for the time period of June 2012 to December 2012 was utilized to determine number of and ND RR as well as ND RR based on length of stay (LOS) of < 7 days or >14 days. Results: During the pre-EHR period, 632 ND were identified with a 30.7% RR (206/632). During the post-EHR period, 8336 ND were identified with a 30.4% RR (2534/8336). When patients had a LOS < 7 days, the ND RR was 12.1% while patients with a LOS > 14 days had an ND RR of 51.8%. The pre- and postEHR ND RR were similar for all patients. The post-EHR RR based on LOS demonstrate a low RR for individuals with a shorter LOS and a higher RR for those with a longer LOS. Conclusion: An EHR-generated report can be useful and more efficient way to gather a large amount of data regarding ND and corresponding RR. Registered Dietitians (RD) should take into account a patient's expected LOS and select ND that can realistically be resolved by RD interventions within the predicted LOS timeframe. Funding Disclosure: None
Learning Outcome: The participant will be able to assess the content validity of the definitions, etiologies and signs/symptoms for the diagnoses, Inadequate Oral Intake and Increased Nutrient Needs Content validation provides evidence that standardized language is accurate and occurs in practice. Few studies have investigated content validity of nutrition diagnoses. This study determined content validity of Inadequate Oral Intake (IOI) and Increased Nutrient Needs (INN), which have been diagnosed in oncology patients. Registered Dietitians, Board Certified Specialists in Oncology Nutrition (RD, CSOs) (n¼462) were emailed a Nutrition Diagnostic Validation Instrument. Participants rated components (definition, etiologies, and sign/symptoms) from 1¼not characteristic to 5¼very characteristic. Diagnostic content validity (DCV) and total DCV scores for components were calculated and classified as major (DCV0.80), minor (DCV<0.80 and >0.50) or not characteristic (DCV0.5). Pearson correlations were computed between scores and years as an RD, as a CSO, practicing oncology nutrition, and diagnosing nutrition problems. Those that responded (n¼165) were CSOs and practiced oncology nutrition an average 2.68 years (SD¼1.34) and 10.22 years (SD¼7.22), respectively. The majority diagnosed nutrition problems 3 years (58.8%, n¼101). Total DCV¼0.69 for IOI with one etiology not characteristic (DCV¼0.41). The other components’ DCV scores ranged from 0.54-0.90, the majority (73.7%, n¼14) minor. Total DCV¼0.74 for INN. The components’ DCV scores ranged from 0.58-0.89, the majority (77.3%, n¼22) minor. The INN's definition correlated significantly with RD tenure, r ¼ -.19, P<0.05, and years practicing oncology nutrition, r ¼ -.22, P<0.01. Those who were RDs and practiced oncology nutrition longer rated the INN's definition less characteristic. These CSOs were somewhat confident the diagnoses represented what occurs in practice. Refinement of the terminology may be warranted as many components were minor. Funding Disclosure: None
September 2013 Suppl 3—Abstracts Volume 113 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-13