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The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi

BACKGROUND: Malnutrition is commonly underdiagnosed and undertreated in acute care patients. Implementation of current pathways of care is limited, potentially as a result of the perception that they are not feasible with current resources. There is a need for a pathway based on expert consensus, be...

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Autores principales: Keller, Heather H, McCullough, James, Davidson, Bridget, Vesnaver, Elisabeth, Laporte, Manon, Gramlich, Leah, Allard, Johane, Bernier, Paule, Duerksen, Donald, Jeejeebhoy, Khursheed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473836/
https://www.ncbi.nlm.nih.gov/pubmed/26089037
http://dx.doi.org/10.1186/s12937-015-0051-y
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author Keller, Heather H
McCullough, James
Davidson, Bridget
Vesnaver, Elisabeth
Laporte, Manon
Gramlich, Leah
Allard, Johane
Bernier, Paule
Duerksen, Donald
Jeejeebhoy, Khursheed
author_facet Keller, Heather H
McCullough, James
Davidson, Bridget
Vesnaver, Elisabeth
Laporte, Manon
Gramlich, Leah
Allard, Johane
Bernier, Paule
Duerksen, Donald
Jeejeebhoy, Khursheed
author_sort Keller, Heather H
collection PubMed
description BACKGROUND: Malnutrition is commonly underdiagnosed and undertreated in acute care patients. Implementation of current pathways of care is limited, potentially as a result of the perception that they are not feasible with current resources. There is a need for a pathway based on expert consensus, best practice and evidence that addresses this crisis in acute care, while still being feasible for implementation. METHODS: A modified Delphi was used to develop consensus on a new pathway. Extant literature and other resources were reviewed to develop an evidence-informed background document and draft pathway, which were considered at a stakeholder meeting of 24 experts. Two rounds of an on-line Delphi survey were completed (n = 28 and 26 participants respectively). Diverse clinicians from four hospitals participated in focus groups to face validate the draft pathway and a final stakeholder meeting confirmed format changes to make the pathway conceptually clear and easy to follow for end-users. Experts involved in this process were researchers and clinicians from dietetics, medicine and nursing, including management and frontline personnel. RESULTS: 80 % of stakeholders who were invited, participated in the first Delphi survey. The two rounds of the Delphi resulted in consensus for all but two minor components of the Integrated Nutrition Pathway for Acute Care (INPAC). The format of the INPAC was revised based on the input of focus group participants, stakeholders and investigators. CONCLUSIONS: This evidence-informed, consensus based pathway for nutrition care has greater depth and breadth than prior guidelines that were commonly based on systematic reviews. As extant evidence for many best practices is absent, the modified Delphi process has allowed for consensus to be developed based on better practices. Attention to feasibility during development has created a pathway that has greater implementation potential. External validation specifically with practitioner groups promoted a conceptually easy to use format. Test site implementation and evaluation is needed to identify resource requirements and demonstrate process and patient reported outcomes resulting from embedding INPAC into clinical practice.
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spelling pubmed-44738362015-06-20 The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi Keller, Heather H McCullough, James Davidson, Bridget Vesnaver, Elisabeth Laporte, Manon Gramlich, Leah Allard, Johane Bernier, Paule Duerksen, Donald Jeejeebhoy, Khursheed Nutr J Research BACKGROUND: Malnutrition is commonly underdiagnosed and undertreated in acute care patients. Implementation of current pathways of care is limited, potentially as a result of the perception that they are not feasible with current resources. There is a need for a pathway based on expert consensus, best practice and evidence that addresses this crisis in acute care, while still being feasible for implementation. METHODS: A modified Delphi was used to develop consensus on a new pathway. Extant literature and other resources were reviewed to develop an evidence-informed background document and draft pathway, which were considered at a stakeholder meeting of 24 experts. Two rounds of an on-line Delphi survey were completed (n = 28 and 26 participants respectively). Diverse clinicians from four hospitals participated in focus groups to face validate the draft pathway and a final stakeholder meeting confirmed format changes to make the pathway conceptually clear and easy to follow for end-users. Experts involved in this process were researchers and clinicians from dietetics, medicine and nursing, including management and frontline personnel. RESULTS: 80 % of stakeholders who were invited, participated in the first Delphi survey. The two rounds of the Delphi resulted in consensus for all but two minor components of the Integrated Nutrition Pathway for Acute Care (INPAC). The format of the INPAC was revised based on the input of focus group participants, stakeholders and investigators. CONCLUSIONS: This evidence-informed, consensus based pathway for nutrition care has greater depth and breadth than prior guidelines that were commonly based on systematic reviews. As extant evidence for many best practices is absent, the modified Delphi process has allowed for consensus to be developed based on better practices. Attention to feasibility during development has created a pathway that has greater implementation potential. External validation specifically with practitioner groups promoted a conceptually easy to use format. Test site implementation and evaluation is needed to identify resource requirements and demonstrate process and patient reported outcomes resulting from embedding INPAC into clinical practice. BioMed Central 2015-06-19 /pmc/articles/PMC4473836/ /pubmed/26089037 http://dx.doi.org/10.1186/s12937-015-0051-y Text en © Keller et al. 2015 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Keller, Heather H
McCullough, James
Davidson, Bridget
Vesnaver, Elisabeth
Laporte, Manon
Gramlich, Leah
Allard, Johane
Bernier, Paule
Duerksen, Donald
Jeejeebhoy, Khursheed
The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi
title The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi
title_full The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi
title_fullStr The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi
title_full_unstemmed The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi
title_short The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi
title_sort integrated nutrition pathway for acute care (inpac): building consensus with a modified delphi
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473836/
https://www.ncbi.nlm.nih.gov/pubmed/26089037
http://dx.doi.org/10.1186/s12937-015-0051-y
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