Abstract
To assess the impact of the implementation of an information technology system using standardized language (International Dietetic and Nutrition Terminology, IDNT) on efficiency and patient outcomes. This was a longitudinal study of hemodialysis patients (≥18 years, ≥3 months dialysis vintage) at a single facility. During the first 6 month period (months 0–6), patients received usual standard of care, with documentation via a manual paper-based system. During the following 6–month period (months 7–12), nutritional care was documented and tracked by a computerized system incorporating IDNT. Improvement or deterioration in nutritional status was determined via routine nutritional assessment and documented using IDNT. Workload efficiency was determined using a Workload Mapping Tool. Difference between systems was assessed using t-test for continuous and chi-square test for categorical variables. Ninety-one patients were recruited at baseline, another 12 patients in the final 6 month intervention period (age (SD) 58 years (16), 53% male (n=55), vintage 43 months (inter-quartile range, 25 to 75 months), malnutrition by SGA, 10.9%). Introduction of the computerized system resulted in a higher rate of resolution of nutritional diagnoses (mean 1.43 (CI 1.19–1.67) compared with the paper-based system (mean 0.68 (CI 0.49–0.87)) (p<0.001). The number of patients exceeding serum phosphate targets (>1.6 mmol/L) decreased from 73% to 59% with introduction of the new system, and dry weight change improved (mean difference 1.6% (SD 5.2) ( p =0.025)). There was no significant difference in malnutrition rates ( p =0.586) or inter-dialytic fluid gains ( p =0.836). Efficiency was improved by an average of 13 minutes per patient per review using the new system ( p <0.001). The implementation of a computerized nutrition care process incorporating IDNT in the hemodialysis population resulted in improved efficiency without compromising nutrition-related outcomes.
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