Malnutrition screening: A screening tool for outpatient oncology patients, leveraging EMR data.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 275-275
Author(s):  
Jeannine B. Mills ◽  
Alice C. Shapiro ◽  
Colleen Spees ◽  
Elaine Trujillo ◽  
Elise Cushman ◽  
...  
Keyword(s):  
Screening Tool ◽  
Medical Oncology ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Clinic Visit ◽  
Nutritional Risk ◽  
Oncology Patients ◽  
Nutrition Risk ◽  
Cancer Centers ◽  
Staffing Patterns

275 Background: The provision of adequate nutritional care in outpatient cancer centers was the focus of a 2016 NAS Workshop, “Assessing Nutrition Care in Outpatient Oncology.” Here we report our internal project evaluating ongoing documentation of a malnutrition screening tool (MST) at 3 national cancer centers (CC). Methods: Screening scores from a validated 2 question MST scale were entered into the EMR. Questions probe for: 1) unintentional weight loss; and 2) eating poorly because of a decreased appetite. A score of ≥ 2 indicated nutrition risk. De-identified oncology clinic visit data were examined monthly to assess MST utilization and scores for radiation and medical oncology patients across the CC’s. Results: Approximately two-thirds (67%) of unique medical oncology patients that visited the CC’s had documented MST data with 9% (n = 144,129) scoring at nutritional risk. MST completion rates were higher in radiation oncology clinics secondary to staff education. Of those that had a valid MST score in radiation clinics, 13% (n = 23,202) of MST scores indicated nutritional risk. Conclusions: The MST is a valid malnutrition screening tool for outpatient oncology patients, yet this tool is not uniformly being utilized nationally. Consistent use of the MST in the electronic medical record and leveraging data on utilization are needed to inform staff compliance, consistency in care, future dietitian staffing patterns, cost/benefit analysis, and health outcomes for oncology patients. [Table: see text][Table: see text]

scholarly journals New screening tool for neonatal nutritional risk in China: a validation study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042467
Author(s):  
Mei Zhou ◽  
Yuwei Li ◽  
Huaying Yin ◽  
Xianhong Zhang ◽  
Yan Hu
Keyword(s):  
Validation Study ◽  
Head Circumference ◽  
Predictive Value ◽  
Screening Tool ◽  
Nutritional Risk ◽  
Risk Level ◽  
Spearman Correlation ◽  
Nutrition Risk ◽  
Sensitivity Specificity ◽  
Nutritional Risk Screening

ObjectiveA neonatal nutritional risk screening tool (NNRST) was developed by using Delphi and analytic hierarchy processes in China. We verified the accuracy of this tool and analysed whether it effectively screened neonates with nutritional risk.DesignProspective validation study.Setting and participantsIn total, 338 neonates who were admitted to the neonatal unit of Children’s Hospital of Chongqing Medical University from May–July 2016 completed the study. Nutritional risk screening and length and head circumference measurements were performed weekly. Weight was measured every morning, and other relevant clinical data were recorded during hospitalisation.Main outcome measuresWe evaluated the sensitivity, specificity, validity, reliability, and positive and negative predictive value of the screening tool. Various characteristics of neonates in different risk groups were analysed to determine the rationality of the nutritional risk classification.ResultsThe sensitivity, specificity, and positive and negative predictive values were 85.11%, 91.07%, 60.61% and 97.43%, respectively. The criterion validity was texted by the Spearman correlation analysis (r=0.530) and independent samples non-parametric tests (p=0.000). The content validity (Spearman correlation coefficient) was 0.321–0.735. The inter-rater reliability (kappa value) was 0.890. Among the neonatal clinical indicators, gestational age, birth weight, length, admission head circumference, admission albumin, admission total proteins, discharge weight, discharge length and head circumference decreased with increasing nutrition risk level; the length of stay and the rate of parenteral nutrition support increased with increasing nutrition risk level. In the comparison of complications during hospitalisation, the incidence of necrotising enterocolitis and congenital gastrointestinal malformation increased with increasing nutrition risk level.ConclusionThe validation results for the NNRST are reliable. The tool can be used to preliminarily determine the degree of neonatal nutritional risk, but its predictive value needs to be determined in future large-sample studies.Trial registration numberChiCTR2000033743.

scholarly journals Inadequate Nutrition Services in Outpatient Cancer Centers (P05-036-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Elaine Trujillo ◽  
Katrina Claghorn ◽  
Suzanne Dixon ◽  
Emily Hill ◽  
Elizabeth Lipinski ◽  
...  
Keyword(s):  
Screening Tool ◽  
National Study ◽  
Full Time ◽  
Online Questionnaire ◽  
Cancer Centers ◽  
Practice Group ◽  
Nutrition Services ◽  
Institutional Review ◽  
Staffing Patterns ◽  
The Ohio State University

Abstract Objectives Nutritional services are a critical component of cancer care, yet Registered Dietitian Nutritionist (RDN) staffing patterns in outpatient cancer centers are poorly documented. The objective of this study was to inform availability of nutrition services by examining RDN staffing and utilization in outpatient cancer centers nationwide. Methods An online questionnaire was developed and approved by the Oncology Nutrition Dietetic Practice Group (a practice group of the Academy of Nutrition and Dietetics) and The Ohio State University Institutional Review Board. The deidentified survey was intended for RDNs who practice at outpatient oncology centers and distributed via Academy email in fall 2017. To avoid duplication, each respondent was prompted to submit one survey per center. Annual analytic cases, representing unique new patients diagnosed and treated at each center, were collected. Data on RDN staffing patterns, reimbursement for services, and malnutrition screening practices were analyzed. Results Over one year, 310 surveys were submitted and 206 provided usable data. Of those, 82% of the centers reported at least one dedicated RDN on staff with an average of 1.7 RDN full-time equivalents. The mean annual analytic cases reported were 2043, representing a RDN-to-patient ratio of 1:1202. During this time, RDNs evaluated an average of 7.5 patients per day, yet 48% of centers did not bill for nutrition services. Over half (54%) of the participating facilities screened for malnutrition using a validated or adapted screening tool, such as the Malnutrition Screening Tool. Conclusions This is the first comprehensive, national study to inform nutrition care provider-to-patient ratio in cancer centers which have at least one dedicated RDN. Screening for malnutrition and billing for nutritional evaluations were not widely practiced in the participating facilities. Our findings indicate that the majority of cancer centers nationally are providing inadequate RDN coverage and have low utilization of nutrition services. Funding Sources N/A.

Hospitalization rates related to coordinated home healthcare services with a community oncology practice.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 273-273
Author(s):  
John F. Sandbach ◽  
John Bachelor ◽  
Kimberly Larson ◽  
Denize Jordan ◽  
Janet Mullins ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Medical Oncology ◽  
Health Agency ◽  
Healthcare Services ◽  
Home Healthcare ◽  
Oncology Patients ◽  
Cancer Centers ◽  
Avoidable Hospitalizations ◽  
Hospitalization Rates ◽  
Oncology Practice

273 Background: Unplanned hospital admissions or hospital re-admissions in cancer patients after discharge cost in excess of 16 billion dollars. Oncology patients are a very high risk of hospitalization despite the involvement of a home healthcare agency. The 30-day medical oncology re-hospitalization rates are reported to be 21.6%. Unplanned hospitalization rates in selected oncology patients over a 12 month period have been reported to be as high as 58%. Methods: A large home health agency and a community based medical oncology practice created a delivery model referred to as the Advanced Community Care Model (ACCM). We are reporting our initial 14 month experience. The initial pilot involved three of the medical group’s six cancer centers. The ACCM created standing intervention orders regarding hydration, nausea/vomiting, central line management, antiemetic and diarrhea and a continuum of monthly management meetings with the agency and the practice. Navigation services by a designated RN were provided. Enhanced interventions with either telephone communication or home visits took place when deemed appropriate. Results: ACCM impacted 60-day hospitalization rates fell a baseline at 6 months into the program from 43% to 22% by the end of the 18 month pilot. Avoidable hospitalizations and re-hospitalizations related to N/V, pain, SOB and infection were less than 10%. The initial program has involved 310 unique patients. Conclusions: The reduction in the 60 day hospitalization rates and the low hospitalization and re-hospitalization rates related to pain control, infection, SOB and infection were below published national averages. The results were felt to be encouraging and the ACCM will be expanded to involve all 7 cancer centers in the practice.

Utilizing technology for malnutrition screening and referrals to nutrition services.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 284-284
Author(s):  
Susan Franco ◽  
Corrine Hanson ◽  
Glenda Woscyna ◽  
Jana Wells ◽  
Meghan McLarney
Keyword(s):  
Nursing Staff ◽  
Screening Tool ◽  
Screening Tools ◽  
Cancer Center ◽  
Oncology Patients ◽  
Record System ◽  
Nutrition Screening ◽  
Nutrition Risk ◽  
Positive Screen ◽  
Nutrition Services

284 Background: The incidence of disease-related malnutrition in oncology patients ranges from 40-80%. This is the highest of all hospital patient groups. Malnutrition is associated with decreased quality of life, increased healthcare costs and intolerance to treatment. Screening for nutrition risk is often lacking in outpatient settings. Electronic health records could be utilized to improve the delivery of validated nutrition screening tools such as the Malnutrition Screening Tool (MST) in outpatient oncology settings. Methods: We designed a pilot project (Feb-July 2018) to administer the MST for outpatient oncology patients seen at the Fred and Pamela Buffett Cancer Center (FPBCC) using an electronic medical record system. “Best Practice Alerts” (BPAs) were used to notify the nursing staff of a patient with a screen that was positive for nutrition risk (MST score ≥3). The BPA recommended a referral to nutrition services; nursing staff could choose to “order” or “do not order" a Nutrition Consult. Results: A total of 2,672 patients received MST screening during the pilot. Out of these, 223 (8%) had a positive screen for nutrition risk; 197 of these were eligible for a nutrition services referral. A BPA “fired” 152 times out of 197 eligible patients (77%). Of the197 eligible patients, 58 (29%) were actually referred to nutrition services. Of these 58 referrals, 43 (74%) were triggered based on a BPA, while the remaining referrals were received outside of a BPA. BPAs failed to fire 45/197 times (23%). Conclusions: An EHR-based nutrition screening system to increase referrals in patients identified at nutrition risk in an outpatient oncology setting was effective for 29% of eligible patients. Barriers encountered included failures in technology as well as human factors. During the pilot it was discovered that the BPA was firing in a location in the chart where the nurse did not regularly work. There was not a consistent message as to the goals and outcomes during the pilot which resulted in lack of awareness by nurses to respond to the nutrition risk score. Utilizing an EHR-based nutrition screening tool is an effective way to identify patients at risk and refer them to appropriate resources in a timely and efficient way.

scholarly journals Triagem nutricional em adultos hospitalizados

2008 ◽  
Vol 21 (5) ◽  
pp. 589-601 ◽  
Author(s):  
Mariur Gomes Beghetto ◽  
Bibiana Manna ◽  
Andréia Candal ◽  
Elza Daniel de Mello ◽  
Carisi Anne Polanczyk
Keyword(s):  
Screening Tool ◽  
Nutritional Assessment ◽  
Risk Index ◽  
Mini Nutritional Assessment ◽  
Nutritional Risk ◽  
Nutritional Screening ◽  
Nutrition Risk ◽  
Nutritional Risk Index ◽  
Assessment Questionnaire ◽  
Nutritional Risk Screening

Em hospitais, o objetivo de um procedimento de triagem nutricional é identificar indivíduos desnutridos ou em risco de desnutrição, possibilitando intervenção nutricional precoce e melhor alocação de recursos. Diferentes métodos são apresentados na literatura para esta finalidade: Malnutrition Screening Tool, Short Nutritional Assessment Questionnaire, Nutritional Risk Index, Nutrition Risk Score, Nutritional Risk Screening, Mini Nutritional Assessment, Malnutrition Universal Screening Tool, Nutritional Screening Tool, Nutritional Screening Equation. No entanto, o emprego de muitos destes instrumentos está limitado pela inadequada metodologia empregada na derivação e/ou validação, pela seleção de grupos específicos de pacientes, pela pouca praticidade ou por necessidade de um especialista para seu emprego. Na ausência de um padrão de referência para emitir o diagnóstico nutricional, desfechos clínicos relevantes devem balizar a derivação e a validação de novos instrumentos. Este trabalho descreve os instrumentos de triagem nutricional acima referidos e apresenta considerações quanto ao seu emprego para adultos hospitalizados não selecionados.

Screened social risk factors & screening acceptability among oncology patients in Philadelphia.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12125-12125
Author(s):  
Jessica Davis ◽  
Lindsey Zinck ◽  
Sheila Kelly ◽  
Hareena Sangha ◽  
Lawrence N. Shulman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Social Isolation ◽  
Screening Tool ◽  
Housing Instability ◽  
Social Risk ◽  
Financial Toxicity ◽  
Social Risk Factors ◽  
Oncology Patients ◽  
Cancer Centers ◽  
Social Screening

12125 Background: This pilot study describes the cancer-specific social risk factors (SRFs) of oncology patients on active treatment and the acceptability of using SRF screening to inform care and bolster support during cancer treatment. Methods: This is an ongoing cross-sectional survey of adult cancer patients on active treatment at two outpatient cancer centers in the University of Pennsylvania Health System. Since October 2019, 176 patients have completed our two-part, 19-item social risk screening tool (44% response rate; 49% age > 65yo; 45% female; 35% non-white). Survey questions were adapted from other social screening measures (e.g., AHC-HRSN tool, PRAPARE), then pre-tested and modified for our cancer-specific population. Part 1 of our tool covers 12 SRFs in four core domains: technology (e.g., internet accessibility challenges), environmental (e.g., housing instability), emotional (e.g., social isolation), and financial (e.g., ongoing financial toxicity). In part 2, seven acceptability questions cover patients’ perceived appropriateness of and comfort with screening, expectations of clinical staff to act on identified SRFs, prior SRF assistance received, interest in receiving SRF assistance (i.e., a proxy for patients’ most pressing unmet social needs), willingness to add SRF data to electronic health records (EHR), and comfort sharing findings with other clinicians (e.g., oncologists, primary care physicians, nurses). Results: We identified an average of 2.48 SRFs per patient. The five most commonly reported SRFs were ongoing financial toxicity (57%), internet accessibility challenges (46%), social isolation (40%), housing instability (34%), and insufficient internet for telemedicine (29%). The majority of patients thought that SRF screening was appropriate (56%) and many felt comfortable being screened (63%). Half of patients expected cancer center staff to connect them to social resources (50%), fewer wanted staff to just be aware of their SRFs (43%), and a minority did not want staff to know about their SRFs (7%). Many patients had received prior SRF assistance (49%) or were interested in receiving future help (51%). Most patients felt discomfort toward listing SRF results in their EHR (63%) and some felt uncomfortable giving other clinicians access to this data (38%). Conclusions: Our study shows that oncology patients contend with SRFs while undergoing treatment and find SRF screening acceptable. These findings support clinical implementation of a cancer-specific social screening tool into routine cancer care, but also bring attention to privacy preferences and limited acceptability of EHR documentation of SRFs. Cancer centers adopting this approach may gain insights into where interventions or resources could be targeted to meaningfully address SRFs, potentially improving clinical outcomes for vulnerable populations.

scholarly journals Inadequate Nutrition Coverage in Outpatient Cancer Centers: Results of a National Survey

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Elaine B. Trujillo ◽  
Katrina Claghorn ◽  
Suzanne W. Dixon ◽  
Emily B. Hill ◽  
Ashlea Braun ◽  
...  
Keyword(s):  
Nutrition Therapy ◽  
National Study ◽  
Full Time ◽  
Online Questionnaire ◽  
Full Time Equivalent ◽  
Oncology Patients ◽  
Cancer Centers ◽  
Nutrition Services ◽  
Ambulatory Oncology ◽  
Staffing Patterns

Cancer-related malnutrition is associated with poor health outcomes, including decreased tolerance to cancer therapy, greater treatment toxicities, and increased mortality. Medical nutrition therapy (MNT) optimizes clinical outcomes, yet registered dietitian nutritionists (RDNs), the healthcare professionals specifically trained in MNT, are not routinely employed in outpatient cancer centers where over 90% of all cancer patients are treated. The objective of this study was to evaluate RDN staffing patterns, nutrition services provided in ambulatory oncology settings, malnutrition screening practices, and referral and reimbursement practices across the nation in outpatient cancer centers. An online questionnaire was developed by the Oncology Nutrition Dietetic Practice Group (ON DPG) of the Academy of Nutrition and Dietetics and distributed via the ON DPG electronic mailing list. Complete data were summarized for 215 cancer centers. The mean RDN full-time equivalent (FTE) for all centers was 1.7 ± 2.0. After stratifying by type of center, National Cancer Institute-Designated Cancer Centers (NCI CCs) employed a mean of 3.1 ± 3.0 RDN FTEs compared to 1.3 ± 1.4 amongst non-NCI CCs. The RDN-to-patient ratio, based on reported analytic cases, was 1 : 2,308. Per day, RDNs evaluated and counseled an average of 7.4 ± 4.3 oncology patients. Approximately half (53.1%) of the centers screened for malnutrition, and 64.9% of these facilities used a validated malnutrition screening tool. The majority (76.8%) of centers do not bill for nutrition services. This is the first national study to evaluate RDN staffing patterns, provider-to-patient ratios, and reimbursement practices in outpatient cancer centers. These data indicate there is a significant gap in RDN access for oncology patients in need of nutritional care.

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