D6 EMR-ization of Standardized Malnutrition Screening and Assessment in Primary Care Across Ontario
June 14, 2017
Theme 6. Using data to demonstrate value and improve quality of care
- Date: Thursday, October 26, 2017
- Concurrent Session D
- Time: 9:30am-10:15am
- Style: Presentation (information provided to audience, with opportunity for audience to ask question)
- Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
- Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Administrative staff, Representatives of stakeholder/partner organizations
- Understand the priority joint initiative of Family Health Team Dietitian (FHT RD) Network and Ontario Primary Health Care Action Group (PHCAG-ON) in collaboration with the Quality Improvement Decision Support Specialists (QIDSS) community
- Learn about the standardized malnutrition screening and assessment process in primary care settings
- Determine the level of readiness on adopting a collaborative interprofessional team approach to identify and manage malnutrition
- Inform the development process of EMR tools to capture outcome data and assess quality of care
- Identify your team’s niche in supporting provincial quality improvement projects
- Background: Despite the fact that 34% Canadians over 65 years are at nutritional risk and 47% of seniors are malnourished on hospital admission, malnutrition is often overlooked. The Dietitians of Canada Ontario Primary Healthcare Action Group (PHCAG) has made malnutrition screening for seniors in primary care settings a priority initiative and has been advocating for standardized malnutrition screening and assessment, a collaborative interprofessional team approach to manage malnutrition and electronic medical record (EMR) customized charting templates to collect outcome data to assess quality of care and support upcoming provincial quality improvement projects.
- Methods: Gaps were identified in practice with respect to malnutrition screening and assessment (eg. low referral rate, variability in assessment approach and lack of standardized data collection). EMR customized charting templates (i.e. encounter assistants) are designed to guide clinical workflow in identifying patient populations, using appropriate screening instruments and processes, and standardizing data collection to facilitate on-going monitoring/evaluation of service quality and effectiveness.
- Results: Malnutrition encounter assistants were created to include 3 validated instruments (eg. CNST, MNA-SF and SCREEN II-AB) appropriate for screening vulnerable seniors (eg. recently discharged from hospital and with cognitive issues). Positive screenings are referred to dietitians for further assessment including subjective global assessment to determine level of malnutrition and appropriate intervention. Nutrition diagnosis, weight status, Mediterranean diet score, hand-grip strength, biochemical tests and internal/external referrals are recorded in the encounter assistants. These encounter assistants have recevied exceptional feedback by the QIDSS community after the dissemination at a weekly teleconference in Winter 2017.
- Implication: New encounter assistants for malnutrition have embedded validated screening/assessment instruments into EMR and simplified the process of data collection. More than 150 dietitians and other providers have been trained at PHCAG RD Research Day, AFHTO conference/webinars and via AFHTO IHP community of practice to screen seniors at nutritional risk in a standardized manner with a systematic approach to outcome measurement. Recommended outcome indicators have been shared with Quality Improvement and Decision Support Specialist (QIDSS) network to facilitate adoption and spread in provincial quality improvement projects.
- Denis Tsang, Registered Dietitian/Lead of AFHTO Diabetes Community of Practice, Carefirst Family Health Team/AFHTO
- Amy Waugh, Registered Dietitian, Upper Grand Family Health Team
- Michele MacDonald Werstuck, Registered Dietitian, Hamilton Family Health Team
Authors & Contributors
- Marg Alfieri, RD, President (Association of Family Health Team of Ontario), Associate Professor (McMaster University), Registered Dietitian (Centre for Family Medicine FHT)
- Jennifer McGregor, RD, Registered Dietitian (Niagara North Family Health Team)
- Ashley Hurley, RD, Registered Dietitian (City of Lakes Family Health Team)
- Lee Kapuscinski, RD, Registered Dietitian (Guelph Family Health Team)