Patient‐reported dietetic care post hospital for free‐living patients: a Canadian Malnutrition Task Force Study

Abstract

Background: Transitions out of hospital can influence recovery. Ideally, malnourished patients should be followed by someone with nutrition expertise, specifically a dietitian, post discharge from hospital. Predictors of dietetic care post discharge are currently unknown. The present study aimed to determine the patient factors independently associated with 30-days post hospital discharge dietetic care for free-living patients who transitioned to the community. Methodology: Nine hundred and twenty-two medical or surgical adult patients were recruited in 16 acute care hospitals in eight Canadian provinces on admission. Eligible patients could speak English or French, provide their written consent, were anticipated to have a hospital stay of ≥2 days and were not considered palliative. Telephone interviews were completed with 747 (81%) participants using a standardised questionnaire to determine whether dietetic care occurred post discharge; 544 patients discharged to the community were included in the multivariate analyses, excluding those who were admitted to nursing homes or rehabilitation facilities. Covariates during and post hospitalisation were collected prospectively and used in logistic regression analyses to determine independent patientlevel predictors. Results: Dietetic care post discharge was reported by 61/544 (11%) of participants and was associated with severe malnutrition [Subjective Global Assessment category C: odd's ratio (OR) 2.43 (1.23-4.83)], weight loss post discharge )], comorbidity [(OR 1.09 (1.02-1.17)] and a dietitian consultation on admission . Conclusions: Dietetic care post discharge occurs in few patients, despite the known high prevalence of malnutrition on admission and discharge. Dietetic care in hospital was the most influential predictor of post-hospital care.

Nutrition Care after Discharge from Hospital: An Exploratory Analysis from the More-2-Eat Study

“…This exploratory analysis found that the most commonly reported nutrition-care activities post-discharge were following information provided in-hospital about food intake/community food related services (44% received info, and 65% followed the information), and use of ONS (26.5%). Only 6.8% of participants reported seeing a dietitian post-discharge, which is consistent with the 11% reported in a previous Canadian study [ 14 ]. Similarly, weight gain, loss, and stability were comparable to other Canadian work [ 14 ].…”

“…Only 6.8% of participants reported seeing a dietitian post-discharge, which is consistent with the 11% reported in a previous Canadian study [ 14 ]. Similarly, weight gain, loss, and stability were comparable to other Canadian work [ 14 ].…”

“…Approximately a quarter of patients report weight loss 30-days after discharge, which was associated with being on a “special” diet (also called a therapeutic diet) and reporting a fair/poor appetite [ 13 ]. This same study found that only 11% of participants reported consulting a dietitian post-discharge and this was associated with severe malnutrition, weight loss after discharge, comorbidity, and having seen a dietitian in hospital [ 14 ]. This research suggests need for nutrition care post-discharge, but potential gaps as well.…”

Pre‐operative nutrition and the elective surgical patient: why, how and what?

“…The CMTF also identified that most patients did not improve their nutritional status during hospitalisation, and that half of the patients who remained in hospital > 7 days were identified as malnourished at discharge. Furthermore, 75% of malnourished patients did not receive care from a dietician during their hospital stay, and only 11% received dietetic care post‐discharge .…”

Scoping review protocol: effectiveness of individualised nutritional care plans to reduce malnutrition during hospitalisation and up to 3 months after discharge

“…A systematic review conducted in 2012 concluded that transitional care initialised in hospitals could yield positive outcomes in hospitalised adult patients 21. One study showed that dietetic care in hospitals was the most influential predictor of post-hospital care 22. Early and extended nutrition intervention can improve nutrition status and reduce length of hospital stay 23.…”