A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients

Objective: To develop and implement a nutrition screening and dietetic referral system for Home and Community Care (HACC) eligible clients. Design: Quality improvement project utilising a prospective, observational design. Setting: Sixteen Australian organisations caring for HACC eligible clients. Subjects: One thousand one hundred and forty-five HACC eligible clients (mean age 76.5 +/- 7.2 years) were screened for nutritional risk during 2003-2005. Interventions: Nutrition screening was conducted by trained project officers, allied health staff, community care coordinators and nursing staff using a modified version of the malnutrition screening tool (MST). Dietitians performed a nutrition assessment using the scored Patient Gene rated-Subjective Global Assessment (PG-SGA) and provided individualised nutrition counselling for those identified to be at risk of malnutrition and agreeing to treatment. Results: According to the MST, 170 clients (15%) were identified as being at risk of malnutrition. Of these, 75 (44%) agreed to the dietetic referral and PG-SGA assessment, and 57 were subsequently assessed as malnourished (PG-SGA category B or C), suggesting a malnutrition prevalence between 5% and 11%. Of the 34 malnourished clients receiving multiple dietetic reviews (mean 4.1 +/- 2.0 per client), 28 improved, with 17 achieving a well-nourished PG-SGA A rating. Conclusion: The development and implementation of a nutrition screening and referral system can identify HACC eligible clients who would benefit from services provided by a dietitian. Further research should identify the reasons why some HACC eligible clients are reluctant to be referred to a dietitian.