Documentation of the evidence-diagnosis link predicts nutrition diagnosis resolution in the Academy of Nutrition and Dietetics' diabetes mellitus registry study: A secondary analysis of Nutrition Care Process outcomes

Abstract

ObjectivesTo describe nutrition care documentation patterns and investigate predictors of nutrition diagnosis resolution.MethodsThis is a secondary data analysis of a 2-year pragmatic, quasi-experimental study conducted in outpatient clinics where nutrition care was provided to adults with diabetes Type 1 or 2 from May 2017 to June 2019 (n = 564 patients). The main outcome measures were frequency of standardized Nutrition Care Process (NCP) terms, NCP links, nutrition diagnosis resolution and predictors of nutrition diagnosis resolution. Predictors of diagnosis resolution were identified using a multivariable logistic regression model.ResultsThe most prevalent resolved diagnoses were excessive carbohydrate intake (32%), undesirable food choices (21%) and excessive energy intake (13%). The top etiology was food and nutrition related knowledge deficit (57%) and interventions were drawn mainly from the Nutrition Education domain (64%). One hundred forty-six patient cases (26%) had at least one follow-up visit and 26% of those with a follow-up (n = 38) had a resolved diagnosis. The presence of the evidence-diagnosis NCP link in documentation predicted diagnosis resolution (OR = 2.80, 95% CI 1.30–6.02; p = 0.008).ConclusionMost diagnoses were caused by patients' lack of knowledge and respective interventions focused on nutrition education. Odds of diagnosis resolution improved when the signs and symptoms of the diagnosis were documented during assessment (evidence-diagnosis NCP link). Training dietitians on NCP links may be important to resolve nutrition diagnoses. Presented findings are hypothesis generating.

Evaluation of the nutrition care process documentation in the patients' records using the Diet‐NCP‐Audit: experience in a medium‐sized multi‐site Swiss hospital

“…To assess critical thinking in EPRs, NCP audit tools should be performed. 8,20,21 In our study, Diet-NCP-Audit items evaluating nutrition intervention (step 3) and nutrition monitoring and evaluation (step 4) received higher scores than steps 1 and 2, even if they were not NCP steps covered by training at the HFR. This finding is consistent with some old and recent papers in which dietitians perceived steps 3 and 4 as less complicated than nutrition diagnosis.…”

“…21 These authors recently showed that the NCP evidence-diagnosis link was the most likely link to increase the odds of diagnosis resolution. 21 And Lewis and colleagues found that this link was the second most likely to do it. 20 Therefore, dietitians should monitor signs and symptoms coming from the assessment part to verify the effectiveness of their interventions on nutrition problems.…”

“…It also provides benefits for the patient, as demonstrated in studies by Lewis and colleagues and in Colin and colleagues, where good-quality NCP documentation helped resolving the nutrition problem. 20,21 To address this weakness, NCP-QUEST has been developed for more specifically assessing critical thinking. 11 This tool evaluates the continuity in NCP, that is, the NCP links (evidence-diagnosis, diagnosis-aetiology, aetiologyintervention, intervention-goal and diagnosis-outcome 23 ).…”

“…17,18,34 Each dietitians' team should have renewed mentor support, that is, NCP champions, to ensure the sustainability of NCP and to train on quality documentation, which is, as mentioned by Colin and colleagues, of paramount importance. 21 Nutrition diagnosis has been implemented at the HFR, and NCP documentation in EPRs is mainly of high quality. However, the link between nutrition assessment and nutrition diagnosis still needs improvement because it is key for the consistency of the entire process.…”

“…Significantly, it has recently been found that when the aetiology was linked to the intervention, the nutrition problem was 50 times likelier to be resolved 20 . The choice of the relevant aetiology is of paramount importance: choosing the wrong one could lead to inefficiency, as measured in Colin and colleagues in a study on NCP documentation in diabetic patients' records 21 . These authors recently showed that the NCP evidence‐diagnosis link was the most likely link to increase the odds of diagnosis resolution 21 .…”