nutrition care pathways or the use of dietetic assistants 1. Such interventions have implications for staff time and may incur additional costs, yet there appears to be a lack of evidence for their efficacy. The aim of this systematic review was to determine the effect of organizational level initiatives designed to support improved dietary intake, on nutritional, clinical and patient-centred outcomes. Searches were undertaken of 9 electronic databases, published systematic reviews and bibliographies to March 2013 and hand searching of abstracts from relevant nursing and nutrition conferences to November 2011. Metaanalysis was conducted using Review Manager v 5.2. 13 randomised controlled trials (RCTs) were identified (n¼ 3397 participants) in patients with dementia (n¼5), hip fracture (n¼2) and elderly patients in residential care (n¼2), hospital (n¼3) or their own homes (n¼1). Interventions consisted of the use of dietetic assistants (1 RCT), multidisciplinary team care (2 RCTs), specialized teaching and training (6 RCTs), protocol-driven nutrition care pathways (2 RCTs) and monitoring by telemedicine (1 RCT). Duration ranged from, a few days of hospital stay to 12 months, and follow-up from 28 days to 12 months. The interventions were associated with significant improvements to weight (mean difference 0.25 kg, 95% confidence interval (CI) 0.41 to 0.09, p¼0.002, I 2 ¼7%) but no significant benefits in mortality (relative risk (RR) 0.73, 95%CI 0.45 to 1.19, p¼0.21, I 2 ¼34%) or length of stay (RR 0.12, 95%CI-0.37 to 0.61, p¼0.63, I 2 ¼50%). There were insufficient comparable data and/or inadequate reporting to undertake analyses for many outcomes (see table below). This systematic review and meta-analysis suggests that initiatives to improve nutritional intake in vulnerable groups implemented at an organizational level may be associated with small improvements in weight compared with usual care. Currently there are insufficient data to indicate whether this is associated with improvements in clinical or patient-centred outcomes. 1. DOH (2010) Essence of Care Benchmarks for Food and Drink. www.gov. uk/ OC22.
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