Optimizing the nutrition support care model: Analysis of survey data

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

doi:10.1002/jpen.2326

Cited by 12 publications

(18 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other factors contributing to this trend could be a lack of physicians developing expertise in nutrition, augmented by the decline in nutrition-focused education in medical schools and residency programs. [20][21][22] Surveys of US medical schools found that only 25% require a dedicated nutrition course providing an average of 19.6 h of nutrition education, a reduction from 30% and 22.3 h noted 6 years earlier. 21 The data are not much better for postgraduate training programs, in which only 26% of programs had a formal curriculum for nutrition and 77% of program directors indicated that education goals for nutrition were not met.…”

Section: Discussionmentioning

confidence: 99%

“…Other factors contributing to this trend could be a lack of physicians developing expertise in nutrition, augmented by the decline in nutrition‐focused education in medical schools and residency programs 20–22 . Surveys of US medical schools found that only 25% require a dedicated nutrition course providing an average of 19.6 h of nutrition education, a reduction from 30% and 22.3 h noted 6 years earlier 21 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics of chronic intestinal failure in the USA based on analysis of claims data

Mundi

Mercer

Iyer

et al. 2022

J Parenter Enteral Nutr

Self Cite

View full text Add to dashboard Cite

Background This study investigated the prevalence, characteristics, and management of patients with chronic intestinal failure (CIF) in the United States in 2012–2020, based on parenteral support (PS) prescription claims and healthcare utilization. Methods Patients with CIF were identified from the Integrated DataVerse® claims database if they had at least two PS prescriptions within 6 months and a relevant diagnosis. Analysis included prevalence and characteristics of patients with CIF, their travel distance to receive PS prescriptions, and the distribution of PS providers and their prescribing history. Results Up to 24,048 patients with CIF were identified, equivalent to 75 patients per million. CIF affected people of all ages, being more prevalent in women than in men. Many providers signed PS orders for small patient groups over short time periods, whereas few providers signed PS orders for large patient groups long term, indicating a lack of centralization. The distribution of PS providers suggested a disparity in healthcare coverage in rural vs urban areas, leading to patients traveling considerable distances to receive PS prescriptions. This may be exacerbated by a decline of providers with expertise in CIF and nutrition. Conclusions Healthcare disparities for patients with CIF have likely been obscured by the lack of CIF‐specific diagnostic and procedure codes, obliging providers to code for their patients under other codes. Effective policy changes, including centralized care, revision of reimbursement models, and expansion of nutrition‐focused education in addition to the newly introduced International Classification of Diseases codes, are needed to provide the best care for patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characteristics of chronic intestinal failure in the USA based on analysis of claims data

Mundi

Mercer

Iyer

et al. 2022

J Parenter Enteral Nutr

Self Cite

View full text Add to dashboard Cite

show abstract

“…NSTs were an early model for collaborative practice, but as nutrition support practice evolved, knowledge was disseminated outside of a formal NST setting. In some instances, formal NSTs may not be necessary because of the adoption of general cross‐discipline collaboration and practice 7,8,55 . However, several concepts for developing highly functional teams have evolved that are applicable to most teams, including NSTs.…”

Section: Characteristics Of Successful Nstsmentioning

confidence: 99%

“…In subsequent years, the NST concept was widely accepted, and the number of NSTs blossomed in a variety of structures (eg, teams, groups, and committees) in various healthcare organizations (eg, acute, long-term acute care, and rehabilitation hospitals) in the United States. [2][3][4][5][6][7][8] Over the past five decades, NSTs have evolved owing to lessons learned, innovations in technology and practices, changes in healthcare financing, and more recently, a pandemic. Parallel to the development of NSTs, the American Society for Parenteral and Enteral Nutrition (ASPEN) developed, disseminated, and revised nutrition support standards, guidelines, and protocols.…”

Section: Introductionmentioning

confidence: 99%

Nutrition support teams: Institution, evolution, and innovation

et al. 2022

View full text Add to dashboard Cite

The historical institution, evolution, and innovations of nutrition support teams (NSTs) over the past six decades are presented. Focused aspects of the transition to transdisciplinary and patient‐centered care, NST membership, leadership, and the future of NSTs are further discussed. NSTs were instituted to address the need for the safe implementation and management of parenteral nutrition, developed in the late 1960s, which requires the expertise of individuals working collaboratively in a multidisciplinary fashion. In 1976, the American Society for Parenteral and Enteral Nutrition (ASPEN) was established using the multidisciplinary model. In 1983, the United States established the inpatient prospective payment system with associated diagnosis‐related groupings, which altered the provision of nutrition support in hospitals with funded NSTs. The number of funded NSTs has waxed and waned since; yet hospitals and healthcare have adapted, as additional education and experience grew, primarily through ASPEN's efforts. Nutrition support was not administered in some instances by the “core of four” (physician, nurse, dietitian, pharmacist). The functions may be carried out by a member of the core of four not associated with the parent discipline, in accordance with licensure/privileging. This cross‐functioning has evolved into the adaptation of the concept of transdisciplinarity, emphasizing function over form, supported and enhanced by “top‐of‐license” practice. In some institutions, nutrition support has been incorporated into other healthcare teams. Future innovations will assist NSTs in providing the right nutrition support for the right patient in the right way at the right time, recognizing that nutrition care is a human right.

show abstract

“…Caring for critically ill patients requires expertise from healthcare professionals in various disciplines. This interprofessional team model is essential to enhance patient outcomes and team performance (1). The critical care dietitian is a key member of the interprofessional team with specialized expertise and complementary functions.…”

mentioning

confidence: 99%

Casting Light on the Necessary, Expansive, and Evolving Role of the Critical Care Dietitian: An Essential Member of the Critical Care Team

Patel

Mundi

Taylor

et al. 2022

Critical Care Medicine

Self Cite

View full text Add to dashboard Cite

Caring for critically ill patients requires expertise from healthcare professionals in various disciplines. This interprofessional team model is essential to enhance patient outcomes and team performance (1). The critical care dietitian is a key member of the interprofessional team with specialized expertise and complementary functions. The following discussion outlines the necessary, expansive, and evolving role of the dietitian for knowledge acquisition, dissemination, and translation within an evolving epoch in critical care nutrition (CCN), defined by the impact of emerging information on practice paradigms. THE IMPACT OF NUTRITIONAL RISK ON CRITICAL CARE OUTCOMESMalnutrition and critical illness have a bidirectional relationship, as both contribute to an increasing degree of nutritional risk (2-4). Nutritional risk is independently associated with more patient complications, increased mortality, greater length of hospital stay, and higher healthcare costs (5,6).Since the 1974 seminal article by Butterworth (7) highlighting the iatrogenic and underrecognized protein-energy malnutrition among hospitalized patients, the past 5 decades have provided us with a better understanding of critical illness pathophysiology and how various nutritional interventions can play a salutary role. Critical illness-induced host inflammatory and immune responses impair gastrointestinal functions. These include impaired epithelial barrier function and gut dysbiosis, which incite gut-derived inflammation and multiple organ dysfunction syndrome (8). The provision of early enteral nutrition (EN) provides a distinct benefit, primarily by maintaining gut barrier functions (9). Additionally, survivorship from critical illness has increased in the past 3 decades (10). Unfortunately, survival is oftentimes accompanied by critical illness-related sarcopenia, protein-energy malnutrition, and impaired quality of life (11-17).These selected examples of the bidirectional relationship between deterioration of nutritional status and critical illness highlight the clear need for expertise in nutrition assessment, diagnosis, and monitoring, as well as implementation of nutritional strategies to modify and even redirect disease trajectory.

show abstract

Optimizing the nutrition support care model: Analysis of survey data

Cited by 12 publications

References 38 publications

Characteristics of chronic intestinal failure in the USA based on analysis of claims data

Characteristics of chronic intestinal failure in the USA based on analysis of claims data

Nutrition support teams: Institution, evolution, and innovation

Casting Light on the Necessary, Expansive, and Evolving Role of the Critical Care Dietitian: An Essential Member of the Critical Care Team

Contact Info

Product

Resources

About