Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial

Autor: A, Duclos, S, Touzet, L, Restier, P, Occelli, F, Cour-Andlauer, A, Denis, S, Polazzi, C, Colin, A, Lachaux, N, Peretti, José, Labarère
Přispěvatelé: Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA)
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Male
Pediatrics
Inservice Training
030309 nutrition & dietetics
[SDV]Life Sciences [q-bio]
Medicine (miscellaneous)
France/epidemiology
law.invention
Dietary Services/manpower
Hospitals
University
0302 clinical medicine
Computer-Assisted
Randomized controlled trial
law
Health care
Prevalence
Cluster Analysis
Diagnosis
Computer-Assisted
030212 general & internal medicine
Cluster randomised controlled trial
Child
Referral and Consultation
2. Zero hunger
Pediatric
0303 health sciences
Nutrition and Dietetics
Hospitals
Pediatric
Hospitals
3. Good health
Child
Preschool
Workforce
Female
France
Guideline Adherence
Hospital Units
medicine.medical_specialty
Pediatrics/*methods
Referral
Adolescent
Nutrition Assessment
Child Nutrition Disorders
03 medical and health sciences
Intervention (counseling)
medicine
Humans
Preschool
Hospital Units/manpower
University
Diagnosis
business.industry
Health Plan Implementation
Infant
Odds ratio
medicine.disease
Malnutrition
Emergency medicine
Child Nutrition Disorders/*diagnosis/diet therapy/epidemiology/etiology
Feasibility Studies
Observational study
business
Dietary Services
Zdroj: European Journal of Clinical Nutrition
European Journal of Clinical Nutrition, Nature Publishing Group, 2015, 69 (7), pp.769-75. ⟨10.1038/ejcn.2014.288⟩
ISSN: 0954-3007
1476-5640
DOI: 10.1038/ejcn.2014.288⟩
Popis: International audience; BACKGROUND/OBJECTIVES: Malnutrition occurs frequently in hospitalized children. We aimed to assess whether a computerized system could lead to improved clinical practices in malnourished children. SUBJECTS/METHODS: Healthcare workers (242) from six departments in a pediatric university hospital participated in a cluster randomized trial, studying 1457 malnourished children hospitalized from September 2009 to August 2011. Following a baseline observational pre-intervention period, all departments were randomized into either intervention or control arms. A computerized malnutrition-screening system was implemented in the intervention group to automatically trigger a dietetic referral in real time. Furthermore, the nutrition support team conducted an awareness campaign with healthcare workers and a leadership-based strategy to reinforce the message during the entire study period. Adherence to practice guidelines (daily weights, investigation of etiology for malnutrition, management by a dietitian and application of refeeding protocols) was compared between pre- and post-intervention periods in both the intervention and trial arms. RESULTS: When compared with the pre-intervention period, the clinical practices were significantly improved within the intervention arm for every outcome (P\textless0.01), whereas remained unchanged in the control arm. In addition, during the post-intervention period, malnutrition etiology investigation by physicians (adjusted odds ratio (OR) of 4.4, 95% confidence interval (CI) 1.7-11.8, P=0.003) and management by a dietitian (OR 2.7, 95% CI 1.0-6.9, P=0.046) occurred more frequently in the intervention clusters. CONCLUSIONS: Implementation of an electronic system to detect malnutrition in real time was associated with a rapid improvement in clinical practices for better care of hospitalized children.
Databáze: OpenAIRE
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