Clinical benefits of a nutrition-focused quality improvement intervention at a safety-net hospital gastrointestinal oncology clinic.

Abstract

e19163 Background: Patients with GI cancer have high rates of malnutrition related poor outcomes. In the GI Oncology clinic at Parkland Health and Hospital System (PHHS), a safety net hospital, the number of GI cancer patients with a documented nutrition assessment by a registered dietitian was 5-7%. The aim of QI project was to increase the rate of documented nutrition assessment by a registered dietitian to 25%. Methods: Three PDSA cycles were conducted after identifying barriers to nutritional interventions. A registered dietitian was assigned to the GI oncology clinic during the 1st PDSA cycle, an adapted Malnutrition Screening Tool (MST) was implemented through the institute electronic medical record during 2nd PDSA cycle, and clinical staff was trained during 3rd PDSA cycle. Patient weight, ECOG performance status, and serum albumin were recorded at initial visit and 3-month follow up from May-July 2019. Paired t Test was performed. Results: Through PDSA cycles, the percentage of GI oncology patients with documented nutrition assessment increased from 5.9% to 21.8% by July 2019 and has sustained over subsequent 6-month period. From May-July 2019, there were 132 new patients seen by the registered dietitian, with 63/132 patients (47.7%) with GI cancer. Between the initial dietitian visit and 3-month follow up, significant average difference in weight -1.14 kg (CI: -2.17, - 0.19; p 0.02) was observed among all patients. However, there was no significant difference observed in average difference in weight in GI cancer patients -0.78 kg (CI: -2.4, +0.9; p = 0.34). Improvement and stability in ECOG performance status was observed in 87.5% of GI cancer patients and there was a non-significant improvement in average difference in serum albumin. Conclusions: Through a nutrition focused QI program on GI cancer patients at high risk of malnutrition, the rate of documented nutrition assessment was doubled. The GI cancer patients maintained weight, ECOG performance status, and serum albumin over 3-months.