The Mealtime Audit Tool (MAT) - Inter-Rater Reliability Testing of a Novel Tool for the Monitoring and Assessment of Food Intake Barriers in Acute Care Hospital Patients.

Abstract

Barriers to food intake (FI) exist in hospital that could exacerbate insufficient FI and malnutrition. The Mealtime Audit Tool (MAT) is a staff-administered clinical assessment tool to identify FI barriers for individual patients. Two studies were completed. The objectives of the first study were to test a draft version of the tool and characterize barriers to food intake in older adults in four diverse hospitals, while the second study aimed to demonstrate the inter-rater reliability of the revised MAT. Multi-site, cross sectional. Four acute care hospitals in Canada. Study 1: 120 older (65+ years, adequate cognition) medical or surgical patients. Study 2: 90 medical or surgical patients. In study 1, participants had barriers experienced at one mealtime assessed with MAT. Descriptive analyses characterized the prevalence of barriers across the hospitals. Revisions were made to the MAT based on recommendations from sites. A revised version was tested for inter-rater reliability in study 2. Intraclass correlation coefficient (ICC) was calculated for total MAT scores from 90 patient meals assessed by two raters. Kappa statistics were calculated for each of the 18 MAT items. Mean (+/- standard deviation) number of barriers experienced in Study 1 was 2.93 +/- 1.58, and in Study 2 was 2.51 +/- 1.19. The revised MAT was reliable with an ICC of 0.68 (95%CI: 0.52-0.79). Ten of 16 items in which kappa could be calculated had at least fair agreement. MAT is sufficiently reliable when used by auditors with minimal training. Routinely auditing mealtimes with MAT could be useful in identifying and removing barriers to food intake for older hospitalized patients.