None listed
Conditions
Brief summary
This is a randomized controlled trial comparing intensive ongoing dietetic management vs usual hospital care, using an intention to treat protocol. Those patients that volunteered were randomly allocated to either the hospital model of care(HMoC) or Ambulatory model of care (AMoC). The HMoC intervention consists of dietetic management throughout the hospitalisation period with referral to other healthcare providers upon discharge ( such as the local community doctor or community support groups or private dietitian). The AMoC intervention consists of the same dietetic management throughout the hospitalization period but with formal requirement to provide ongoing support from a team of community based dietitians for up to 6 months after discharge. The primary outcome measures will be ; the change in nutritional status, evaluation of the patients dietetic management goals, assessment of the quality of the patients’ diet and patient level of satisfaction with the service provided. The secondary outcome measures collected will be mortality, readmission rates and total bed days occupied during the six month study period,
Interventions
Two current models of care will be employed during the intervention period and they are described below:
a) Hospital Model of Care ( HMoC):
Patients who receive the HMoC will receive the following services:
1. Full nutrition assessment as per departmental standards
2. Nutrition care plan developed and implemented during the hospital admission. Discretionary referral to the ambulatory care dietitian.
3. All the Dietary Education provided during hospital admission
4. Long term care plan develope
Two current models of care will be employed during the intervention period and they are described below: a) Hospital Model of Care ( HMoC): Patients who receive the HMoC will receive the following services: 1. Full nutrition assessment as per departmental standards 2. Nutrition care plan developed and implemented during the hospital admission. Discretionary referral to the ambulatory care dietitian. 3. All the Dietary Education provided during hospital admission 4. Long term care plan developed and managed by the hospital dietitian. 5. Time allocation is determined by the needs of the patient but is usually in the range of 60-90 minutes per admission. b) Ambulatory Model of Care ( AMoC): Patients who receive the AMoC will receive the following services: 1. Full nutrition assessment as per departmental standards 2. Nutrition care plan developed and implemented during the hospital admission and immediate referral to the ambulatory care dietitian. 3. Minimal Dietary Education provided during hospital admission. 4. Long term care developed and managed by the ambulatory care dietitian. 5. Time allocation is determined by the AMoC dietitian but will be in the range of 3-6 monthly visits and these take approximately 30-60 minutes. Process 1. During the intervention period the hospital dietitians providing the service to these wards will assess all patients referred using a standardised nutritional assessment tool. If the patient is identified as either at risk or malnourished they will be offered a six month check up after the leave hospital. If the patient accepts this service they will also be screened for eligibility into the study. 2. If patients are eligible for inclusion into the study they will be approached by staff member who does not work on these wards and they will discuss the research study and provide and invite then to participate. If they elect to participate their names will be given to the allocation officer. 3. Details on all patients who meet the eligibility criteria will be forwarded to the allocation officer (AO). This AO will randomly allocate these patients to one of the two models of care. Once allocation has been completed the hospital dietitian will be notified as to what model of care their patients will receive for the next six months. 4. If their patients are allocated the HMoC , they follow the inpatient HMoC protocol as outlined in a). 5. If their patients are allocated the AMoC they follow the inpatient AMoC protocol as outlined in b). This model of care requires the ward dietitian to liaise with ambulatory care dietitian during their patients’ admission in hospital. However, once the patient is discharged from hospital all care is managed by the ambulatory care dietitian.
Sponsors
Wollongong Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients admitted to either the general medical or surgical wards who are identified as at risk of malnutrition or malnourished and who will be returning to their home after discharge
Exclusion criteria
Palliative patients Those being discharged to a higher level of care facility then where they were preadmission
Outcome results
None listed