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

Study Overview
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Brief Summary
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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
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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.

Official Title
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More-2-Eat Phase 2: Spread/Scaling up Improved Nutrition Care to Detect and Treat Hospital Malnutrition.

Conditions
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Malnutrition

Intervention / Treatment
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* Combination Product: Integrated Nutrition Pathway for Acute Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient on the study unit Exclusion Criteria: patients not on the study unit

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Royal Alexandria<br>Administrative records | Combination Product: Integrated Nutrition Pathway for Acute Care<br>* 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<br>|
| Pasqua Regional hospital<br>Administrative records | Combination Product: Integrated Nutrition Pathway for Acute Care<br>* 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<br>|
| Concordia Hospital<br>Administrative records | Combination Product: Integrated Nutrition Pathway for Acute Care<br>* 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<br>|
| Niagara General Hospital<br>Administrative records | Combination Product: Integrated Nutrition Pathway for Acute Care<br>* 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<br>|
| Hospital 6<br>Administrative Records | Combination Product: Integrated Nutrition Pathway for Acute Care<br>* 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<br>|
| Hospital 7<br>Administrative Records | Combination Product: Integrated Nutrition Pathway for Acute Care<br>* 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<br>|
| Hospital 8<br>Administrative Records | Combination Product: Integrated Nutrition Pathway for Acute Care<br>* 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<br>|
| Hospital 9<br>Administrative Records | Combination Product: Integrated Nutrition Pathway for Acute Care<br>* 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<br>|
| Hospital 10<br>Administrative records | Combination Product: Integrated Nutrition Pathway for Acute Care<br>* 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<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| success with implementation | rates of screening, diagnosis and treatment with medication pass per month of the study | 19 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse events while in hospital (fall, new infection etc.) |  | 19 months | 
| Length of stay | Average length of stay for patients admitted to the study unit; monthly average | 19 months | 
| Readmission rate | number of patients per month discharged and readmitted to the hospital within 30 days | 19 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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malnutrition, screening, assessment, treatment