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

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

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.

Study Overview

• Status: Completed
• Conditions: Malnutrition
• Intervention / Treatment: Combination product: Integrated Nutrition Pathway for Acute Care

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.

• Study Type: Observational
• Enrollment (Actual): 5158

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada
      • Royal Alexander Hospital
  • Manitoba
    • Brandon, Manitoba, Canada
      • Brandon Regional Health Centre
    • Winnipeg, Manitoba, Canada
      • Concordia Hospital
  • Nova Scotia
    • Halifax, Nova Scotia, Canada
      • Victoria General Hospital
  • Ontario
    • London, Ontario, Canada
      • London Health Sciences Centre
    • Napanee, Ontario, Canada
      • Lennox Addington County General Hospital
    • Niagara Falls, Ontario, Canada
      • Niagara Health Systems
    • Thunder Bay, Ontario, Canada
      • Thunder Bay Regional Health Sciences Centre
  • Saskatchewan
    • Regina, Saskatchewan, Canada
      • Pasqua Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• 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

Description

Inclusion Criteria:

• Patient on the study unit

Exclusion Criteria:

• patients not on the study unit

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Prospective

Number of groups / cohorts

9

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Royal Alexandria; Administrative records	Combination product: Integrated Nutrition Pathway for Acute Care; 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
Pasqua Regional hospital; Administrative records	Combination product: Integrated Nutrition Pathway for Acute Care; 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
Concordia Hospital; Administrative records	Combination product: Integrated Nutrition Pathway for Acute Care; 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
Niagara General Hospital; Administrative records	Combination product: Integrated Nutrition Pathway for Acute Care; 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
Hospital 6; Administrative Records	Combination product: Integrated Nutrition Pathway for Acute Care; 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
Hospital 7; Administrative Records	Combination product: Integrated Nutrition Pathway for Acute Care; 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
Hospital 8; Administrative Records	Combination product: Integrated Nutrition Pathway for Acute Care; 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
Hospital 9; Administrative Records	Combination product: Integrated Nutrition Pathway for Acute Care; 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
Hospital 10; Administrative records	Combination product: Integrated Nutrition Pathway for Acute Care; 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

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: University of Waterloo
• Collaborators: Canadian Frailty Network; Canadian Malnutrition Task Force
• Investigators: Principal Investigator: Heather Keller, PhD, University of Waterloo

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2018
• Primary Completion (Actual): December 30, 2019
• Study Completion (Actual): December 31, 2019

Study Registration Dates

• First Submitted: January 1, 2018
• First Submitted That Met QC Criteria: January 1, 2018
• First Posted (Actual): January 5, 2018

Study Record Updates

• Last Update Posted (Actual): February 11, 2020
• Last Update Submitted That Met QC Criteria: February 9, 2020
• Last Verified: February 1, 2020

More Information

Terms related to this study

• Keywords: malnutrition, screening, assessment, treatment
• Additional Relevant MeSH Terms: Nutrition Disorders; Malnutrition
• Other Study ID Numbers: KT2017-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: UWSpace at the University of Waterloo
• IPD Sharing Time Frame: 2020
• IPD Sharing Supporting Information Type: Analytic Code

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No