Can provision of ambulatory nutrition services to patients discharged from acute care improve health outcomes at an acceptable cost?

Patients admitted in General Medicine ward will be screened for malnutrition by a member of research team, using Malnutrition Universal Screening tool(MUST) and those found to be malnourished will be stratified according to cognitive status into two groups - cognitively normal and cognitively impaired and will be referred to a dietitian who will perform a detailed nutritional assessment using PG-SGA(Patient Generated Subjective Global Assessment) tool and patients will be randomized to intervention and control group. Patients in the intervention group will receive nutritional intervention which may include dietary modification or nutritional supplements and will be followed every month by a telephone call to check compliance for two months and at the end of three months will be seen in dietary clinic for repeat nutritional assessment and cost benefit analysis will be calculated and patients in the control group will follow usual care which does not include prolonged ambulatory dietary intervention. Nutrition Intervention: The dietitian will set realistic goals negotiated with the patient in an effort to prevent decline in nutritional status. The PG-SGA and calculation of estimated requirements will provide guidance on areas of potential nutritional inadequacy and the diet intervention will be tailored to address these. The duration of nutritional intervention will be single one hour session at the baseline and thirty minutes reviews.