Nutrition Support Tool for Assessing Needs

(NSAT Trial)

Overseen By Nina Diamond, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Thomas Jefferson University

Disqualifiers: Unsheltered, Hospice, Communication barriers, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to refine and test a new tool to help healthcare providers identify and address the unique nutrition needs of patients leaving the hospital. The tool provides patients with personalized nutrition advice and referrals, such as access to food support programs, based on their specific life circumstances and health status. This includes various nutrition interventions to support recovery. The trial seeks participants who have been admitted to certain hospitals, experience food insecurity or malnutrition, and live in a specific service area. As an unphased trial, it offers participants the opportunity to contribute to innovative solutions for improving post-hospital nutrition care.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that the Nutrition Support Assessment Tool is safe for assessing nutrition needs?

Research shows that nutrition programs, such as SNAP (Supplemental Nutrition Assistance Program), are generally easy for people to follow. Studies have found that these programs can help change eating habits and improve dietary choices. No major reports of negative effects have emerged from these types of nutrition programs. This suggests that the method used in the Nutrition Support Assessment Tool (NSAT) should be safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it introduces a personalized approach to nutrition support, which stands out from traditional, one-size-fits-all dietary guidelines. Unlike standard options that may not consider individual nutritional needs, this intervention tailors food provisions and supplemental support based on each participant’s specific responses to the Nutrition Support Assessment Tool (NSAT). This customization aims to more effectively address personal dietary requirements, potentially leading to better health outcomes and improved quality of life.

What evidence suggests that the Nutrition Support Assessment Tool is effective for individualized nutrition referrals?

Research shows that nutrition programs can greatly improve health. For example, the Supplemental Nutrition Assistance Program (SNAP) helps people obtain enough food and eat healthier. A review of several studies found that SNAP-Ed programs made it easier for people to access healthy food. Some research also suggests these programs can lead to better health and lower medical costs. This evidence supports the idea that personalized nutrition support, such as the Nutrition Intervention under study in this trial, could significantly improve health by meeting individual dietary needs. ^{5 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for patients being discharged from acute care at Jefferson Health. It's designed to test a new tool, the NSAT, which helps identify personalized nutrition needs and referrals based on patient information like cooking facilities and medical conditions.

Inclusion Criteria

Currently admitted to Thomas Jefferson University or Methodist Hospital or Emergency Department

Eats by mouth

Has working phone number and is willing to participate in follow-up data collection

Exclusion Criteria

Deaf or has other major communication barriers that compromises ability to participate in study activities

Unwilling to provide consent

Unsheltered/unhoused

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Nutrition Intervention

Participants receive an individualized food provision and/or supplemental food support referral based on responses to the NSAT

4 weeks

2 visits (in-person)

Follow-up

Participants are monitored for the uptake, acceptability, appropriateness, and satisfaction of nutrition interventions

4 weeks

2 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Nutrition Interventions

Trial Overview The study is testing the Nutrition Support Assessment Tool (NSAT) to see if it can effectively determine individualized nutrition referrals that are suitable for patients after they leave hospital care.

How Is the Trial Designed?

Group I: Nutrition Intervention Experimental Treatment 1 Intervention

Participants receive an individualized food provision and/or supplemental food support referral based on responses to the NSAT.

Who Is Running the Clinical Trial?

Thomas Jefferson University

Lead Sponsor

Trials

475

Recruited

189,000+

The MANNA Institute

Collaborator

Trials

1

Recruited

200+

Published Research Related to This Trial

The study identified 11 nutrition screening tools for detecting undernutrition in acute care and hospital-based settings, with the Malnutrition Screening Tool (MST) being the only one proven to be both valid and reliable.

Among the tools evaluated, the NRS-2002 received the highest quality grade (Grade I), while four others, including the MST, received Grade II, indicating that effective and user-friendly screening tools are available for healthcare providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nutrition screening tools: an analysis of the evidence. Skipper, A., Ferguson, M., Thompson, K., et al.[2012]

In a study of 46 children with inflammatory bowel disease, three nutrition screening tools (STAMP, STRONGkids, and PNRS) showed good agreement in identifying malnutrition risk, while the PYMS tool had only modest agreement with the others.

Despite the tools' effectiveness in identifying risk, there was a lack of correlation between the screening results and actual malnutrition determined by anthropometric measurements, suggesting that these tools may not fully capture nutritional impairment in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. Wiskin, AE., Owens, DR., Cornelius, VR., et al.[2022]

A comprehensive assessment approach using the ABCDEFQ scale is essential for effectively addressing childhood malnutrition, covering various factors like nutrition, health, and quality of life.

The proposed IMPACT tool aims to evaluate quality of life and guide interventions, integrating UNICEF's recommended infant and young child feeding practices into dietary assessments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Crusade against Malnutrition: Nutrition Education Program. Elizabeth, KE.[2022]

Nutrition screening is crucial for identifying patients who need further nutrition assessment, but many tools used in hospitals lack validation for specific care settings and patient populations.

Several validated nutrition screening tools, such as the Malnutrition Universal Screening Tool and Nutritional Risk Screening 2002, have been shown to effectively identify patients needing nutritional intervention, highlighting the importance of selecting the right tool for the specific clinical context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nutrition screening tools for hospitalized patients. Anthony, PS.[2022]

A nutrition registry established at The University of Illinois Medical Center revealed that 55% of patients were moderately or severely malnourished upon admission, highlighting a significant risk of protein-energy malnutrition in hospitalized patients.

Patients who were well-nourished at admission but became malnourished during their stay incurred much higher hospital charges, indicating that effective nutritional interventions could potentially reduce healthcare costs and improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Creating a clinical nutrition registry: prospects, problems, and preliminary results. Braunschweig, CA.[2019]

A performance improvement process in a 28-bed ICU led to better patient outcomes by increasing the use of enteral nutrition over parenteral nutrition and starting nutrition support sooner.

The implementation of educational programs and a systematic approach resulted in meeting patients' protein and energy needs, ultimately enhancing nutrition support practices and achieving cost savings for the community hospital.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhanced enteral and parenteral nutrition practice and outcomes in an intensive care unit with a hospital-wide performance improvement process. Schwartz, DB.[2019]

A study involving 100 patients and focus groups with 30 ward staff and 6 dietitians revealed that redesigning nutrition care plans significantly improved adherence to nutritional support actions, increasing from 9% to 52% for patients at moderate or severe risk of malnutrition.

Barriers to effective care plan completion included time pressures and operational issues, highlighting the need for ongoing training and strategic improvements in delivering nutritional care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving adherence to a care plan generated from the Malnutrition Universal Screening Tool. Cooper, C., Brierley, ER., Burden, ST.[2013]

Evaluations of dietary risk indicators in the WIC program show that individual dietary assessments, like 24-hour recalls or food frequency questionnaires, often have significant errors, leading to a high chance of misclassification.

Despite individual inaccuracies, these dietary assessments can still yield valid information at the group level, suggesting a need for improved statistical methods and indicator development for better management of nutrition education programs like WIC.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Methodological challenges in performing targeting: assessing dietary risk for WIC participation and education. Caulfield, LE.[2023]

The Nutrition Support Service (NSS) evaluates and provides nutrition support to 500 patients annually, using standardized forms to ensure consistent assessments across medical, dietetic, nursing, and pharmacy teams.

The structured approach of the NSS, including detailed nutrition assessments and specific order forms for enteral and parenteral nutrition, enhances the accuracy of care delivery and serves as a valuable resource for training healthcare professionals and conducting quality assurance and clinical research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A standardized system for assessment and delivery of nutrition support in a large teaching hospital. Cicci, A., Sunyecz, LA., Mirtallo, J., et al.[2017]

A new method for collecting dietary data from 125 children in Liberia improved accuracy by using general terms instead of specific English words like 'food' and 'to eat', which helped reduce communication errors.

This approach revealed that infants in Liberia are introduced to non-breast-milk foods at an average age of 1.9 months, which is 2 to 4 months earlier than previously reported, highlighting the importance of precise communication in dietary studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intercultural communication in assessing dietary habits: Liberia as an example. Jarosz, LA.[2021]

The study developed 44 monitoring indicators to assess adherence to 19 key practice standards in specialized nutritional support, which can help improve the quality of care.

These indicators are categorized into numeric measures of goal achievement, yes/no assessments of improvement actions, and results from practice audits, providing a comprehensive framework for evaluating the effectiveness of nutritional support processes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Indicators monitoring the process of specialized nutritional support. Grupo de Nutrición de la SEFH]. Sirvent, M., Victoria Calvo, M., Sagalés, M., et al.[2013]

The computerized dietary assessment system developed at Chedoke-McMaster Hospitals allows dietitians to efficiently calculate nutrient intakes for both hospitalized and ambulatory patients, taking only 10 to 15 minutes for a one-day assessment.

This system has been well-received by hospital nutritionists, aiding in setting dietary goals, monitoring patient progress, and enhancing patient education on nutrition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A computer application for dietary analysis in clinical nutrition. Sharp, MM., Ahmed, K.[2006]

A reliable 27-question Knowledge, Attitudes, and Practices (KAP) questionnaire was developed and validated, showing strong reliability in measuring hospital staff's understanding of malnutrition care (KA: ICC = 0.69, P: ICC = 0.84).

The KAP questionnaire was administered to 189 staff across five hospitals, revealing a mean score of 93.6/128, indicating generally high knowledge and positive practices regarding malnutrition, with variations based on profession and years of experience.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quality Nutrition Care: Measuring Hospital Staff's Knowledge, Attitudes, and Practices. Laur, C., Marcus, H., Ray, S., et al.[2020]

A study involving 111 healthcare professionals in Yogyakarta, Indonesia, found that while 70% believed the current dietary assessment tool for monitoring food intake was simple, it was criticized for being tedious and time-consuming, leading to challenges in accurately recording patients' nutritional intake.

The findings suggest a need for a more efficient and user-friendly dietary assessment tool, as well as increased awareness and training among healthcare professionals regarding the importance of monitoring patients' nutrient intake to prevent malnutrition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Needs assessment for patients food intake monitoring among Indonesian healthcare professionals. Budiningsari, D., Shahar, S., Abdul Manaf, Z., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9803386/

Supplemental Nutrition Assistance Program as a health ... A study of 1999–2014 NHANES data found that between 2003 and 2014, SNAP participants had less improvements in diet quality using American Heart Association (AHA) ...

2. eatrightpro.org eatrightpro.org/news-center/public-policy-news/snap-summary-of-science

SNAP: Summary of Science A 2019 narrative review of 14 studies found that SNAP-Ed interventions statistically improved food security in the three studies that reported ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S2475299124000258

E-health Dietary Interventions for Participants of SNAP and ... The objective of this systematic literature review was to summarize the effectiveness, acceptability, and feasibility of e-health dietary interventions among ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11792874/

A Randomized Intervention of Supplemental Nutrition ... These results highlight a strong need for effective dietary interventions to improve intakes of foods containing shortfall nutrients. Previous studies have ...

5. cbpp.org cbpp.org/research/food-assistance/snap-is-linked-with-improved-health-outcomes-and-lower-health-care-costs

SNAP Is Linked With Improved Health Outcomes and ... Research emerging in the last 15 years suggests that SNAP may affect household well-being in ways that extend beyond its intended aim to improve ...

6. fns.usda.gov fns.usda.gov/data-research

Data & Research | Food and Nutrition Service This dashboard describes the economic and demographic characteristics of households participating in SNAP by state and over time, as well as SNAP participation ...

7. cdc.gov cdc.gov/nutrition/php/resources/food-and-food-system-resources.html

Food Assistance and Food System Resources | Nutrition Several resources are available for food in everyday situations as well as before, during, and after emergencies and disasters.

8. fns.usda.gov fns.usda.gov/

USDA Food and Nutrition Service USDA's Food and Nutrition Service website provides information to the public about nutrition assistance programs and how to apply.

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10388411/

Pantry clients and Supplemental Nutrition Assistance ... The present study sought to identify factors influencing capacity and readiness to implement healthy eating PSE interventions in food pantries.