Optimizing the nutrition support care model: Analysis of survey data

Manpreet S Mundi; Jeffrey I Mechanick; Osman Mohamed Elfadil; Jayshil J Patel; Sara L Bonnes; Allison B Blackmer; Vikram J Christian; Sara A Hennessy; Ryan T Hurt; Ajay Jain; Matthew B Kaspar; Jennifer Katz; Reginald Labossiere; Berkeley N Limketkai; Paul J McCarthy; Chet A Morrison; Carolyn Newberry; Jose M Pimiento; Martin D Rosenthal; Beth Taylor; Stephen A McClave; ASPEN Physician Engagement Committee

doi:10.1002/jpen.2326

Optimizing the nutrition support care model: Analysis of survey data

JPEN J Parenter Enteral Nutr. 2022 Sep;46(7):1709-1724. doi: 10.1002/jpen.2326. Epub 2022 Feb 16.

Authors

Manpreet S Mundi¹, Jeffrey I Mechanick², Osman Mohamed Elfadil¹, Jayshil J Patel³, Sara L Bonnes⁴, Allison B Blackmer^{5

6}, Vikram J Christian⁷, Sara A Hennessy⁸, Ryan T Hurt⁴, Ajay Jain⁹, Matthew B Kaspar¹⁰, Jennifer Katz¹¹, Reginald Labossiere¹², Berkeley N Limketkai¹³, Paul J McCarthy¹⁴, Chet A Morrison¹⁵, Carolyn Newberry¹⁶, Jose M Pimiento¹⁷, Martin D Rosenthal¹⁸, Beth Taylor¹⁹, Stephen A McClave²⁰; ASPEN Physician Engagement Committee

Affiliations

¹ Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
² The Marie-Josee and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart and the Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³ Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁴ Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁵ American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA.
⁶ Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA.
⁷ Division of Pediatric Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA.
⁸ Division of Burn, Trauma, Acute and Critical Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁹ Division of Pediatric Gastroenterology, Saint Louis University, Saint Louis, Missouri, USA.
¹⁰ Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
¹¹ Division of Gastroenterology and Hepatology, New York University Langone Medical Center, New York, New York, USA.
¹² Birmingham/Atlanta Geriatric Reserach, Education, and Clinical Center, Veterans Integrated Service Network 07, Duluth, Georgia, USA.
¹³ Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA.
¹⁴ Division of Cardiovascular Critical Care, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
¹⁵ Division of Trauma and Critical Care, Central Michigan University College of Medicine, Pleasant, Michigan, USA.
¹⁶ Division of Gastroenterology, Innovative Center for Health and Nutrition in Gastroenterology (ICHANGE), Weill Cornell Medical Center, New York, New York, USA.
¹⁷ Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
¹⁸ Division of Trauma and Acute Care Surgery, University of Florida, Gainesville, Florida, USA.
¹⁹ Department of Research for Patient Care Services, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
²⁰ Division of Gastroenterology, Hepatology, and Nutrition, School of Medicine, University of Louisville, Louisville, Kentucky, USA.

PMID: 35040154
DOI: 10.1002/jpen.2326

Abstract

Background: Malnutrition is underrecognized and underdiagnosed, despite high prevalence rates and associated poor clinical outcomes. The involvement of clinical nutrition experts, especially physicians, in the care of high-risk patients with malnutrition remains low despite evidence demonstrating lower complication rates with nutrition support team (NST) management. To facilitate solutions, a survey was designed to elucidate the nature of NSTs and physician involvement and identify needs for novel nutrition support care models.

Methods: This survey assessed demographics of NSTs, factors contributing to the success of NSTs, elements of nutrition education, and other barriers to professional growth.

Results: Of 255 respondents, 235 complete surveys were analyzed. The geographic distribution of respondents correlated with population concentrations of the United States (r = 90.8%, p < .0001). Most responding physicians (46/57; 80.7%) reported being a member of NSTs, compared with 56.5% (88/156) of dietitians. Of those not practicing in NSTs (N = 81/235, 34.4%), 12.3% (10/81) reported an NST was previously present at their institution but had been disbanded. Regarding NSTs, financial concerns were common (115/235; 48.9%), followed by leadership (72/235; 30.6%), and healthcare professional (HCP) interest (55/235; 23.4%). A majority (173/235; 73.6%) of all respondents wanted additional training in nutrition but reported insufficient protected time, ability to travel, or support from administrators or other HCPs.

Conclusion: Core actions resulting from this survey focused on formalizing physician roles, increasing interdisciplinary nutrition support expertise, utilizing cost-effective screening for malnutrition, and implementing intervention protocols. Additional actions included increasing funding for clinical practice, education, and research, all within an expanded portfolio of pragmatic nutrition support care models.

Keywords: chronic care model; malnutrition; medical economics; medical nutrition; nutrition; nutrition support; nutrition support teams; reimbursement.

MeSH terms

Humans
Malnutrition* / prevention & control
Malnutrition* / therapy
Nutrition Therapy*
Nutritional Support / methods
Patient Care Team
Surveys and Questionnaires
United States

Grants and funding

R01 DK131136/DK/NIDDK NIH HHS/United States