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

200 Participants Needed

Trial Summary

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 data supports the idea that Nutrition Support Tool for Assessing Needs (also known as: Nutrition Interventions) is an effective treatment?

The available research shows that using a systematic approach to nutrition support, like the Nutrition Support Tool for Assessing Needs, can improve patient outcomes. For example, in an intensive care unit, a performance improvement process that included a nutrition support decision tree led to better nutrition practices and outcomes, such as meeting patients' protein and energy needs more effectively. This approach also resulted in quality improvement and cost savings. Additionally, a standardized system for nutrition assessment and delivery in a large hospital helped ensure consistent and effective nutrition support, providing a framework for teaching healthcare professionals and improving care quality. ^{1 2 3 4 5}

What safety data exists for the Nutrition Support Tool for Assessing Needs treatment?

The provided research does not directly address safety data for the Nutrition Support Tool for Assessing Needs or Nutrition Interventions. The studies focus on dietary risk assessment, nutrition registries, dietary analysis software, standardized nutrition support systems, and intercultural communication in dietary assessments. None of these specifically evaluate the safety of the treatment in question. ^{1 6 7 8 9}

Is the treatment Nutrition Interventions a promising treatment?

Nutrition Interventions can be promising because they help identify and support people who need better nutrition, especially in hospitals and for children with specific health issues. Using tools to assess nutrition needs can lead to better health outcomes by ensuring that people get the right kind of nutrition support. ^{10 11 12 13 14}

What is the purpose of this trial?

The research team developed the Nutrition Support Assessment Tool (NSAT) that incorporates key patient life information (e.g., ability to cook, access to refrigerator/stove, medical conditions and nutritional status) to facilitate individualized nutrition referral. The overall goal of this study is to refine and test the NSAT as a systematic approach to provide individualized nutrition needs screening and referral for patients being discharged from the acute care setting at Jefferson Health. The investigators hypothesize the NSAT will be successful in identifying individualized nutrition referrals that are deemed acceptable and appropriate by enrolled participants.

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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 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]

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]

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]

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]

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 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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

A standardized system for assessment and delivery of nutrition support in a large teaching hospital. [2017]

2. Switzerland pubmed.ncbi.nlm.nih.gov

Quality Nutrition Care: Measuring Hospital Staff's Knowledge, Attitudes, and Practices. [2020]

3. United States 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. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Improving adherence to a care plan generated from the Malnutrition Universal Screening Tool. [2013]

5. England pubmed.ncbi.nlm.nih.gov

Needs assessment for patients food intake monitoring among Indonesian healthcare professionals. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

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

7. United States pubmed.ncbi.nlm.nih.gov

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

8. Canada pubmed.ncbi.nlm.nih.gov

A computer application for dietary analysis in clinical nutrition. [2006]

9. United States pubmed.ncbi.nlm.nih.gov

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

10. England pubmed.ncbi.nlm.nih.gov

Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. [2022]

11. India pubmed.ncbi.nlm.nih.gov

Crusade against Malnutrition: Nutrition Education Program. [2022]

12. United States pubmed.ncbi.nlm.nih.gov

Nutrition screening tools for hospitalized patients. [2022]

13. United States pubmed.ncbi.nlm.nih.gov

Nutrition screening tools: an analysis of the evidence. [2012]

14. Spain pubmed.ncbi.nlm.nih.gov

[Indicators monitoring the process of specialized nutritional support. Grupo de Nutrición de la SEFH]. [2013]