(P08-005-23) The Effect of Adding a Registered Dietitian to the Interdisciplinary Team on Malnutrition Diagnosis and Nutrition Care in Long-Term Care Residents

Objectives: To assess the effect of an on-staff RD on long-term care (LTC) health outcomes in residents at risk for malnutrition.

Methods: Data records from a rural LTC facility in Arkansas were used to assess study outcomes from January to December of 2021. RD-led patient centered care was initiated in summer’21. Prior to a MD was responsible for malnutrition screenings and subsequent nutrition care of residents using either weight change or meal intake, but not both, for diagnosing malnutrition. The RD followed the AND guidelines for malnutrition assessment. Weight and meal-intake data was available for both, the traditional (MD) and patient-centered approach (RD). Cohen’s kappa was used to compare agreement between the two malnutrition diagnostics. A two-way repeated measures ANOVA was used to compare provider care approaches on patient weight and meal-intake outcomes over a 6-month time period.

Results: MD and RD malnutrition diagnosis showed poor agreement, k=.100, p= .380. While malnutrition diagnosis frequency was similar, MD: 9 LTC residents (11.6%), RD 10 LTC residents (12.9%), only 2 LTC residents (2.6%) were diagnosed across providers. 60 LTC residents (77.9%) were diagnosed “no malnutrition present” by both providers. Patient weight across time was unaffected by provider, F_{2.38, 178.17} =.352, p =.740, ε =.475 with no main effects for provider, F_1,76 =.054, p =.816 or time, F_{2.77, 207.51} =.971 p =.402, ε =.553. Percent meal intake differed by provider across time F_{2.81, 213.19} = 4.55, p = .005, ε = .561. Meal intake percentages were not different between providers during the first month of assessment (∆ 2.42 % [95% CI, -1.42 to 6.25]). By month 2, meal intake percentages were lower with RD care (-4.08 % [95% CI, -8.06 to -.10], p=.045) and remained below MD care intake values for month 3, (-6.82 % [95% CI, -11.12 to -2.52], p=.002); and month 4, (-5.21 % [95% CI, -9.42 to -1.00, p=.016). By month 5 thru 6, inter-provider differences subsided (-3.05 % [95% CI, -7.27 to 1.17] p=.154 & 1.99 (95% CI, -2.63 to 6.60, p=.394, respectively).

Conclusions: Our data indicated poor agreement of malnutrition diagnosis between providers, there was no effect on weight management for participants regardless of the provider. Changes in the nutrition care plan providers likely caused temporary meal intake declines during main mealtimes.

Funding Sources: Judy Waller Travel Award