Clinical trial NCT03391752: More-2-Eat Phase 2: Scaling and Spread of the Integrated Nutrition Pathway for Acute Care
Official title: More-2-Eat Phase 2: Spread/Scaling up Improved Nutrition Care to Detect and Treat Hospital Malnutrition.
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Malnutrition
Keywords: malnutrition, screening, assessment, treatment
Lead sponsor: University of Waterloo
Sponsor class: OTHER
Collaborators: name: Canadian Malnutrition Task Force
name: Canadian Frailty Network
First posted: 2018-01-05
Enrollment: 5158
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: OTHER
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: all patients admitted to study units in one of the 10 hospitals included will be subject to the improved nutrition care processes; those that are malnourished will be offered a variety of treatments including medication pass

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.

Eligibility criteria: Inclusion Criteria:

* Patient on the study unit

Exclusion Criteria:

* patients not on the study unit

Primary outcomes:
measure: success with implementation
timeFrame: 19 months
Secondary outcomes:
measure: Adverse events while in hospital (fall, new infection etc.)
timeFrame: 19 months
measure: Length of stay
timeFrame: 19 months
measure: Readmission rate
timeFrame: 19 months
Other outcomes:
Locations:
city: Edmonton
country: Canada
facility: Royal Alexander Hospital
state: Alberta
city: Brandon
country: Canada
facility: Brandon Regional Health Centre
state: Manitoba
city: Winnipeg
country: Canada
facility: Concordia Hospital
state: Manitoba
city: Halifax
country: Canada
facility: Victoria General Hospital
state: Nova Scotia
city: London
country: Canada
facility: London Health Sciences Centre
state: Ontario
city: Napanee
country: Canada
facility: Lennox Addington County General Hospital
state: Ontario
city: Niagara Falls
country: Canada
facility: Niagara Health Systems
state: Ontario
city: Thunder Bay
country: Canada
facility: Thunder Bay Regional Health Sciences Centre
state: Ontario
city: Regina
country: Canada
facility: Pasqua Hospital
state: Saskatchewan
Study officials:
affiliation: University of Waterloo
name: Heather Keller, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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.