More-2-Eat Phase 2: Scaling and Spread of the Integrated Nutrition Pathway for Acute Care

NCT ID: NCT03391752

Last Updated: 2020-02-11

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 5158 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2018-05-01
• Study Completion Date: 2019-12-31

Brief Summary

More-2-Eat Phase 2 provides the opportunity to extend the implementation of the Integrated Nutrition Pathway to a total of 10 hospitals and more than 20 medical/surgical units. Building on the success of More-2-Eat Phase 1, key components of this implementation study will be a registry for self-managed data entry and reports and a community of practice to support implementation of nutrition screening at admission to hospital, subjective global assessment to diagnose and triage patients to care pathways and medication pass of a small amount of nutrient dense oral nutritional supplement. Success with implementation and impact on key patient outcomes will be determined.

Detailed Description

Malnutrition in hospital patients is a growing problem, with 20-45% of patients already malnourished at admission. As 70% of malnourished patients are also frail, early detection and treatment of malnutrition is one way to improve the outcomes of frail older adults. To improve the detection and treatment of these conditions, the PI developed the Integrated Nutrition Pathway for Acute Care (INPAC) that guides hospital staff on when to conduct key nutrition care activities to improve outcomes (e.g. screening at admission).

In More-2-Eat (April 2015-March 2017), 5 Canadian hospital units in 4 provinces received funding to implement INPAC. Each hospital, with support from a research team had 1 year to implement INPAC. All 5 hospitals were successful in improving detection and treatment of malnutrition, and started to screen for frailty. Clinical care was transformed in the study units; for example all sites progressed from low baseline or no screening at admission to a rate of 75%. Findings also demonstrate improvement in clinical outcomes such as a shorter length of stay. An online INPAC Implementation Toolkit was developed to promote mobilization of this knowledge. What is not known is whether or not the results can be replicated under normal circumstances (i.e., no external funding for implementation at a hospital site).

To sustain and expand on this success, a Phase 2 knowledge translation project is proposed that will involve the five original Phase 1 sites and five further hospitals as Phase 2 sites. The goal of the second phase is to see if Phase 1 sites can spread success to other units within their hospitals and if Phase 2 sites can achieve similar results across a broader group of patients.

The end product will be a sustainable model including a community of practice supported by our partner the Canadian Malnutrition Task Force, and a self-serve registry that allows sites to collect and report data to change their practice. Investigators will also confirm capacity of INPAC activities to improve clinical outcomes across diverse settings. This knowledge translation and implementation study will demonstrate the potential to transform clinical nutrition care, benefiting all pre-frail and frail older adults.

Conditions

Malnutrition

Study Design

• Observational Model Type: OTHER
• Study Time Perspective: PROSPECTIVE

Study Groups

Royal Alexandria

Administrative records

Integrated Nutrition Pathway for Acute Care

Intervention Type: COMBINATION_PRODUCT

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Pasqua Regional hospital

Administrative records

Integrated Nutrition Pathway for Acute Care

Intervention Type: COMBINATION_PRODUCT

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Concordia Hospital

Administrative records

Integrated Nutrition Pathway for Acute Care

Intervention Type: COMBINATION_PRODUCT

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Niagara General Hospital

Administrative records

Integrated Nutrition Pathway for Acute Care

Intervention Type: COMBINATION_PRODUCT

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Hospital 6

Administrative Records

Integrated Nutrition Pathway for Acute Care

Intervention Type: COMBINATION_PRODUCT

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Hospital 7

Administrative Records

Integrated Nutrition Pathway for Acute Care

Intervention Type: COMBINATION_PRODUCT

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Hospital 8

Administrative Records

Integrated Nutrition Pathway for Acute Care

Intervention Type: COMBINATION_PRODUCT

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Hospital 9

Administrative Records

Integrated Nutrition Pathway for Acute Care

Intervention Type: COMBINATION_PRODUCT

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Hospital 10

Administrative records

Integrated Nutrition Pathway for Acute Care

Intervention Type: COMBINATION_PRODUCT

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Interventions

Integrated Nutrition Pathway for Acute Care

algorithm to guide care processes with respect to nutrition e.g. screening on admission, diagnosis with subjective global assessment, early treatment with medication pass of oral nutritional supplement

Intervention Type: COMBINATION_PRODUCT

Eligibility Criteria

Inclusion Criteria

• Patient on the study unit

Exclusion Criteria

• patients not on the study unit

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Canadian Malnutrition Task Force

OTHER

Sponsor Role: collaborator

Canadian Frailty Network

OTHER

Sponsor Role: collaborator

University of Waterloo

OTHER

Sponsor Role: lead

Responsible Party

Heather Keller

Schlegel-University of Waterloo Research Chair, Nutrition & Aging

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Heather Keller, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Waterloo

Locations

Royal Alexander Hospital

Edmonton, Alberta, Canada

Brandon Regional Health Centre

Brandon, Manitoba, Canada

Concordia Hospital

Winnipeg, Manitoba, Canada

Victoria General Hospital

Halifax, Nova Scotia, Canada

London Health Sciences Centre

London, Ontario, Canada

Lennox Addington County General Hospital

Napanee, Ontario, Canada

Niagara Health Systems

Niagara Falls, Ontario, Canada

Thunder Bay Regional Health Sciences Centre

Thunder Bay, Ontario, Canada

Pasqua Hospital

Regina, Saskatchewan, Canada

Countries

Canada

References

Laur C, Bell J, Valaitis R, Ray S, Keller H. The role of trained champions in sustaining and spreading nutrition care improvements in hospital: qualitative interviews following an implementation study. BMJ Nutr Prev Health. 2021 Sep 28;4(2):435-446. doi: 10.1136/bmjnph-2021-000281. eCollection 2021.

Reference Type: DERIVED

PMID: 35028514 (View on PubMed)

Other Identifiers

KT2017-01

Identifier Type: -

Identifier Source: org_study_id