Nutrition Care Process: Measuring Outcomes

Nutrition Care Process:  Measuring Outcomes

The Nutrition Care Process (NCP) is made up of four steps:

• Nutrition Assessment
• Nutrition Diagnosis
• Nutrition Intervention
• Nutrition Monitoring and Evaluation

This article will cover an important aspect in the fourth step in the NCP (Nutrition Monitoring and Evaluation):  Measuring outcomes

Once the Nutrition Intervention is provided to the patient, it is important to evaluate the intervention’s effectiveness.  The purpose of this is to determine the degree of progress being made and whether the patient’s goals or desired outcomes of nutrition care are being achieved.  So, what is an outcome?  Outcomes are the results hoped to achieve as a result of an intervention.  Additional important terms when measuring outcomes include:  Indicators, reference standards, and variance

• Indicators:  Data measured from results of an intervention which are compared to reference standards
• Reference Standards:  The ideal range or measurement based on scientific evidence
• Variances:  Any differences between the outcome’s actual indicator value (patient’s data measured) and that of the reference standard range

Types of Outcomes

There are four different types of outcomes that may be measured to indicate the effectiveness of the patient’s intervention:  Direct nutrition, clinical and health status, patient-centered, and healthcare.  For each of the categories below, we will use the example of a patient who is unable to consume food orally in a safe manner, and the intervention provided was the initiation of a feeding tube

Direct nutrition outcome:  A result of the nutrition intervention on the patient’s nutritional status.  This may include knowledge gained, behavior changes, food or nutrient intake changes, and improved nutritional status

• Outcomes:  The patient is meeting his calorie, macronutrient, and micronutrient needs because of the enteral nutrition formula
• Indictors:  Caloric and nutrient intake analysis before and after the initiation of enteral nutrition
• Reference standards:  Dietary Reference Intakes (DRIs)

Clinical and health status outcome:  Any changes by the nutrition intervention on the patient’s overall medical condition.  This may include laboratory values, anthropometry and body composition, blood pressure, and risk factor profile

• Outcomes:  A healthy weight is maintained, and the patient’s lab values are normalized
• Indictors:  Any weight changes and recent bloodwork
• Reference standards:  Body mass index, height and weight tables, and reference values for lab data

Patient-centered outcome:  Any changes implemented that improve the quality of life or well-being of the patient.  This may include quality of life, satisfaction, self-efficacy, and self-management

• Outcomes:  The patient regains his strength and physical abilities and can resume his normal daily activities
• Indicators:  The patient’s post-hospitalization daily activity schedule
• Reference standards:  The patient’s pre-hospitalization daily activity schedule prior to becoming ill

Healthcare outcome:  The costs, benefits, and efficiency of the healthcare provided to the patient.  This may include medication changes, special procedures, and planned or unplanned healthcare visits

• Outcomes:  The patient does not need to be readmitted to the hospital due to poor nutritional status
• Indicators:  The number of hospital visits needed by the patient and associated costs
• Reference standards:  Minimal to no hospital stays required, and the patient’s insurance costs