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• W2160202214 abstract "The Academy of Nutrition and Dietetics (Academy) supports nutrition screening as the first step to identify patients at nutritional risk who would benefit from seeing a registered dietitian nutritionist (RDN).1Lacey K. Pritchett E. Nutrition care process and model: ADA adopts road map to quality care and outcomes management.J Am Diet Assoc. 2003; 103: 1061-1072Abstract Full Text Full Text PDF PubMed Scopus (280) Google Scholar Nutrition screening is a supportive task that triggers the entry of a patient into the Academy’s Nutrition Care Process (NCP), a standardized process to identify nutrition-related problems and provide appropriate intervention. However, nutrition screening and nutrition assessment are terms often used interchangeably in the literature and in practice despite their differences. This could lead to confusion.1Lacey K. Pritchett E. Nutrition care process and model: ADA adopts road map to quality care and outcomes management.J Am Diet Assoc. 2003; 103: 1061-1072Abstract Full Text Full Text PDF PubMed Scopus (280) Google Scholar The different functions of nutrition screening and assessment in the context of malnutrition are the focus of this narrative. In 1995, The Joint Commission mandated that all patients be screened for nutrition risk to determine whether a patient would benefit from a full nutrition assessment.2The Joint Commission on Accreditation of Healthcare OrganizationsComprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH). Joint Commission on Accredittion of Healthcare Organizations, Oakbrook Terrace, Ill1996Google Scholar Screening must be done within 24 hours of admission to an acute care facility. The Academy supports this approach3American Dietetic AssociationIdentifying patients at risk: ADA's definitions for nutrition screening and nutrition assessment.J Am Diet Assoc. 1994; 94: 838-839Abstract Full Text Full Text PDF PubMed Scopus (121) Google Scholar as do the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and the European Society for Parenteral and Enteral Nutrition.4Kondrup J. Allison S.P. Elia M. Vellas B. Plauth M. ESPEN guidelines for nutrition screening 2002.Clin Nutr. 2003; 22: 415-421Abstract Full Text Full Text PDF PubMed Scopus (2072) Google Scholar, 5Mueller C. Compher C. Ellen D.M. Parenteral tASf, Directors ENBoA.S.P.E.N. clinical guidelines: Nutrition screening, assessment, and intervention in adults.JPEN J Parenter Enteral Nutr. 2011; 35: 16-24Crossref PubMed Scopus (487) Google Scholar, 6Alliance to Advance Patient Nutrition. http://malnutrition.com/. Accessed July 31, 2014.Google Scholar However, The Joint Commission does not mandate the tool or criteria to be used for nutrition screening, which leads to wide variation in methods used between sites.7Patel V. Romano M. Corkins M.R. et al.Nutrition screening and assessment in hospitalized patients: A survey of current practice in the United States.Nutr in Clin Pract. 2014; 29: 483-490Crossref PubMed Scopus (64) Google Scholar The Academy defines nutrition screening as “the process of identifying patients, clients, or groups who may have a nutrition diagnosis and benefit from nutrition assessment and intervention by a registered dietitian.”8Academy of Nutrition and Dietetics. Definitions and criteria. Nutrition Screening Evidence Analysis Project. 2014. http://andevidencelibrary.com/topic.cfm?cat=3958. Accessed May 12, 2014.Google Scholar Similarly, A.S.P.E.N., an interdisciplinary organization whose members span the health care continuum (registered nurses [RNs], RDNs, pharmacists, physicians, scientists, and other nutrition support health professionals) define nutrition screening as “a process to identify an individual who is malnourished or who is at risk for malnutrition to determine if a detailed nutrition assessment is indicated.”9Amercian Society for Parenteral and Enteral Nutrition (APSEN). Board of Directors and Clinical Practice Committee. Definitions of terms, styles, and conventions used in APSEN. Board of Directors-approved documents. July 2010. http://www.nutritioncare.org/Clinical_Practice_Library/. Accessed September 22, 2014.Google Scholar In contrast, the longer, more detailed nutrition assessment process identifies (diagnoses) a nutrition problem and recommends an intervention. Simply, screening determines “risk” of a problem and assessment determines “presence” of a problem. Malnutrition is estimated to affect 30% to 50% of adult hospital patients in the United States,10Jensen G.L. Compher C. Sullivan D.H. Mullin G.E. Recognizing malnutrition in adults: Definitions and characteristics, screening, assessment, and team approach.JPEN J Parenter Enteral Nutr. 2013; 37: 802-807Crossref PubMed Scopus (85) Google Scholar but only 3.2% of these patients are discharged with a diagnosis of malnutrition.11Corkins M.R. Guenter P. DiMaria-Ghalili R.A. et al.Malnutrition diagnoses in hospitalized patients: United States, 2010.JPEN J Parenter Enteral Nutr. 2014; 38: 186-195Crossref PubMed Scopus (155) Google Scholar Therefore, many patients are either well-nourished on admission to the hospital and malnutrition develops during their stay,12Somanchi M. Tao X. Mullin G.E. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition.JPEN J Parenter Enteral Nutr. 2011; 35: 209-216Crossref PubMed Scopus (125) Google Scholar are malnourished when they are admitted and are overlooked, or both. It is well-documented that malnourished patients have worse outcomes compared to well-nourished patients, including increased length of hospital stay, number of readmissions, decreased function and quality of life, increased mortality, and higher health care costs.13Jensen G.L. Bistrian B. Roubenoff R. Heimburger D.C. Malnutrition syndromes: A conundrum vs continuum.JPEN J Parenter Enteral Nutr. 2009; 33: 710-716Crossref PubMed Scopus (122) Google Scholar, 14Chima C.S. Barco K. Dewitt M.L.A. Maeda M. Teran J.C. Mullen K.D. Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service.J Am Diet Assoc. 1997; 97: 975-978Abstract Full Text Full Text PDF PubMed Scopus (249) Google Scholar, 15Correia M.I.T.D. Waitzberg D.L. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis.Clin Nutr. 2003; 22: 235-239Abstract Full Text Full Text PDF PubMed Scopus (1247) Google Scholar Pressure ulcers are twice as likely to develop in malnourished hospital patients compared with well-nourished patients,16Banks M. Bauer J. Graves N. Ash S. Malnutrition and pressure ulcer risk in adults in Australian health care facilities.Nutrition. 2010; 26: 896-901Crossref PubMed Scopus (102) Google Scholar and the risk of surgical site infections is three times higher.17Fry D.E. Pine M. Jones B.L. Meimban R.J. Patient characteristics and the occurrence of never events.Arch Surg. 2010; 145: 148-151Crossref PubMed Scopus (89) Google Scholar Use of an inappropriate screening tool (one that has not been validated or has been validated in a different population) negatively influences patient care and risks misdiagnosis (or missed diagnosis) of nutrition-related problems. Other risks include wasting resources, such as clinician time and health care dollars, and most importantly, poor patient outcomes. Therefore, identification and treatment of these patients through an appropriate screening and assessment process is a critical concern to health care providers, patients and families, hospital administrators, and third-party payers. In 2003 the Academy adopted the Nutrition Care Process and Model (NCP), a standardized process for nutrition and dietetics practitioners to use critical thinking and decision-making skills to address nutrition-related problems and provide quality care.1Lacey K. Pritchett E. Nutrition care process and model: ADA adopts road map to quality care and outcomes management.J Am Diet Assoc. 2003; 103: 1061-1072Abstract Full Text Full Text PDF PubMed Scopus (280) Google Scholar The NCP, updated in 2008,18Writing Group of the Nutrition Care Process/Standardized Language CommitteeNutrition care process and model part I: The 2008 update.J Am Diet Assoc. 2008; 108: 1113-1117Abstract Full Text Full Text PDF PubMed Scopus (144) Google Scholar consists of four steps to be done in sequence: (a) Nutrition Assessment, (b) Nutrition Diagnosis, (c) Nutrition Intervention, and (d) Nutrition Monitoring and Evaluation. These four steps have corresponding standardized terminology, called the NCP Terminology (NCPT), that supports consistent use of language in documentation of nutrition care. Nutrition screening is a supportive task that triggers the entry of a patient into the NCP. Nutrition screening identifies patients who need to be seen by an RDN. Screening is most often completed by someone other than a nutrition and dietetics practitioner (eg, nurse), and does not require formal nutrition training. In fact, a recent survey showed that in 86% of facilities, nurses conduct the screening.7Patel V. Romano M. Corkins M.R. et al.Nutrition screening and assessment in hospitalized patients: A survey of current practice in the United States.Nutr in Clin Pract. 2014; 29: 483-490Crossref PubMed Scopus (64) Google Scholar Screening should be quick, simple, valid (sensitive and specific), reliable, and done regularly to capture changes in risk.8Academy of Nutrition and Dietetics. Definitions and criteria. Nutrition Screening Evidence Analysis Project. 2014. http://andevidencelibrary.com/topic.cfm?cat=3958. Accessed May 12, 2014.Google Scholar, 19Skipper A. Ferguson M. Thompson K. Castellanos V.H. Porcari J. Nutrition screening tools: An analysis of the evidence.JPEN J Parenter Enteral Nutr. 2012; 36: 292-298Crossref PubMed Scopus (163) Google Scholar As part of the nutrition care planning process, The Joint Commission also mandates regular re-screening of patients, including those who were not at nutritional risk on admission. For both initial and re-screening, The Joint Commission leaves specific policies and procedures to the discretion of each facility. Therefore, between facilities, there is variation in who completes the screening, what tool is used, and when re-screening is required. The Academy defines nutrition assessment as the process “to obtain, verify, and interpret data needed to identify nutrition-related problems, their causes, and significance.”20Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. http://ncpt.webauthor.com. Accessed August 5, 2014.Google Scholar A nutrition assessment provides the foundation for the other three steps of the NCP by providing information for determining the nutrition diagnosis and also for understanding the cause of the diagnosis (ie, the etiology), and should be done by a trained nutrition professional. An understanding of the etiology helps the RDN determine the most feasible and effective intervention to implement for resolution of the diagnosis. Assessment information/data are organized into five categories: (a) food/nutrition-related history; (b) anthropometric measurements; (c) biochemical data, medical tests, and procedures; (d) nutrition-focused physical findings; and (e) client/patient history.20Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. http://ncpt.webauthor.com. Accessed August 5, 2014.Google Scholar Single nutrition assessment findings alone do not warrant a nutrition diagnosis; rather, they are collectively used in the documentation of a nutrition diagnosis and etiology and help to direct nutrition intervention and identify outcomes to monitor. The clinician identifies signs and symptoms (assessments) to support each diagnostic term defined in the NCPT. Groups of assessments that are commonly used together and are validated may be referred to as diagnostic tools. Examples of diagnostic tools for malnutrition are the Subjective Global Assessment21Detsky A.S. McLaughlin J.R. Baker J.P. et al.What is subjective global assessment of nutritional status?.JPEN J Parenter Enteral Nutr. 1987; 11: 8-13Crossref PubMed Scopus (2266) Google Scholar (SGA) and the Malnutrition Clinical Characteristics (MCC).22White J.V. Guenter P. Jensen G. Malone A. Schofield M. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition).J Acad Nutr Diet. 2012; 112: 730-738Abstract Full Text PDF PubMed Scopus (404) Google Scholar Before a nutrition screening tool is implemented in a health care setting, it is important to determine if the tool has been validated.23Anthony P.S. Nutrition screening tools for hospitalized patients.Nutr Clin Pract. 2008; 23: 373-382Crossref PubMed Scopus (159) Google Scholar Tools may be validated in a general population or in a specific subgroup and may be designed to identify general nutrition concerns or a specific risk, such as risk of malnutrition. To test the validity of screening or assessment tools, the tool in question is tested against a gold standard (reference standard) that identifies one group of individuals who have the disease and another group of individuals who do not have the disease or condition. Some gold standards include a biopsy, angiography, autopsy, lab test result, or a diagnostic tool (such as SGA). A new assessment tool would generally be compared with an existing assessment tool that has been validated (convergent validity). Similarly, screening tools are generally validated in one of two ways: (a) the new screening tool is tested against a valid screening tool (convergent validity), or (b) the new screening tool is tested against a valid assessment tool (predictive validity). A valid screening tool will have high sensitivity (patients identified as at risk of malnutrition are generally malnourished) and a high specificity (patients not at risk are in fact well-nourished).24Ferguson M. Capra S. Bauer J. Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients.Nutrition. 1999; 15: 458-464Crossref PubMed Scopus (555) Google Scholar See Figure 1 for relevant definitions and how to calculate sensitivity and specificity. Screening tools attempt to identify risk and the need for further testing (assessment) rather than a definite diagnosis. Therefore, it is most important to not miss people who may have the disease; false negatives must be avoided, whereas false positives can be accepted in screening. In assessment, the balance between sensitivity and specificity is more nuanced and must be based on any risk that could be incurred by treating an individual who does not have the disease.Figure 1Common measurements used when testing the validity of a nutrition screening or assessment tool as compared to a gold standard.TermDefinitionExampleSensitivityThe proportion of subjects with disease in whom a test is positive. Also called positive in disease. Sensitivity=True Positive/(True Positive+False Negative)A patient who is identified as at risk on the screening tool is likely to also be malnourished.SpecificityThe proportion of subjects without the disease being tested for in whom a test is negative. Also called negative in health.Specificity=True Negative/(True Negative+False Positive)A patient who is identified as not at risk on the screening tool is likely to also be well-nourished.Positive predictive value (PPV)The probability that a person with a positive test result has the disease being tested for.PPV=True Positive/(True Positive+False Positive)The likelihood that a patient who is found to be malnourished according to a new nutrition assessment tool is malnourished when measured by a gold standard existing tool.Negative predictive value (NPV)The probability that a person with a negative test result does not have the disease being tested for.NPV=True Negative/(True Negative+False Negative)The likelihood that a patient who is found to be well-nourished according to a new nutrition assessment tool is well-nourished when measured by a gold standard existing tool. Open table in a new tab Ideally, a valid tool will be 100% sensitive and specific, meaning that all patients screened will correctly be identified as at risk for malnutrition (sensitivity) or not at risk for malnutrition (specificity). This is generally not considered realistic; therefore, it is important to balance false positives and negatives. Figure 2 illustrates the properties of a valid nutrition screening tool modeled after the Malnutrition Screening Tool (MST).24Ferguson M. Capra S. Bauer J. Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients.Nutrition. 1999; 15: 458-464Crossref PubMed Scopus (555) Google Scholar Because of the sensitivity (93%) of the MST, it is highly probable that a malnourished patient will be identified as at risk during screening. In an ideal situation, these at-risk patients would be assessed by an RDN and most would be diagnosed with malnutrition (as evidenced by the large number of patients in the upper left box [true positive] in Figure 2). After a malnutrition diagnosis, patients would receive nutrition interventions aimed at resolving the diagnosis. However, if a screening tool with low sensitivity was used instead, malnourished patients might not be identified as at risk (increasing the number of patients in the lower left box [false negative] in Figure 2) and an RDN would be less likely to be consulted to see the patient, decreasing the likelihood of a nutrition intervention. In the second situation, the patient is more likely to be readmitted to the hospital, have an increased mortality rate and higher health-care costs, have decreased function and quality of life, and have a longer length of stay compared with a malnourished patient13Jensen G.L. Bistrian B. Roubenoff R. Heimburger D.C. Malnutrition syndromes: A conundrum vs continuum.JPEN J Parenter Enteral Nutr. 2009; 33: 710-716Crossref PubMed Scopus (122) Google Scholar, 14Chima C.S. Barco K. Dewitt M.L.A. Maeda M. Teran J.C. Mullen K.D. Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service.J Am Diet Assoc. 1997; 97: 975-978Abstract Full Text Full Text PDF PubMed Scopus (249) Google Scholar, 15Correia M.I.T.D. Waitzberg D.L. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis.Clin Nutr. 2003; 22: 235-239Abstract Full Text Full Text PDF PubMed Scopus (1247) Google Scholar who enters the NCP and receives a nutrition intervention.25Stratton R.J. Hébuterne X. Elia M. A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions.Ageing Res Rev. 2013; 12: 884-897Crossref PubMed Scopus (133) Google ScholarFigure 22×2 illustration of sensitivity and specificity based on the Malnutrition Screening Tool for 10,000 patients when compared with a gold standard assessment tool. The bullets describe the hypothetical clinical scenario of patients with each combination of screening and assessment results.Registered Dietitian Nutritionist (RDN) Assessment Positive for MalnutritionRDN Assessment Negative for MalnutritionScreening Result PositiveTrue Positive: Number of patients who are correctly classified as malnourished (n=1,568)•Screening tool identifies the patient at risk for malnutrition.•RDN completes full nutrition assessment as part of the Nutrition Care Process (NCP).•RDN diagnoses patient as malnourished, patient receives appropriate nutrition intdervention and monitoring/evaluation.•Ideally, better patient outcomes than a malnourished patient who did not receive an intervention.False Positive: Number of patients misclassified as being malnourished (n=588)•Screening tool identifies the patient at risk for malnutrition.•RDN completes full nutrition assessment as part of the NCP.•RDN does not diagnose the patient as malnourished, the patient is well-nourished.•While assessing a well-nourished person, the RDN could have spent time assessing an at-risk patient.•Patient should be rescreened for risk of malnutrition regularly throughout hospital stay.Positive Predictive Value1,568 (True Positive)/1,568 (True Positive)+588 (False Positive)=73%Screening Result NegativeFalse Negative: Number of patients misclassified as being well-nourished (n=124)•Screening tool does not identify the patient at risk for malnutrition.•RDN does not complete a nutrition assessment. However, if the RDN had completed an assessment (such as in a validation study), the RDN would have diagnosed the patient as malnourished.•The patient is likely to have poor outcomes: Increased number of readmissions, length of stay, mortality, and health care costs, and decreased function and quality of life.•Patient should be rescreened for risk of malnutrition regularly throughout hospital stay.True Negative: Number of patients correctly classified as being well-nourished (n=7,720)•Screening tool does not identify the patient at risk for malnutrition.•RDN is not consulted, no nutrition assessment is completed. If the assessment had been completed, the RDN would have identified no nutrition problems (well-nourished).•No additional nutrition intervention is required.•Patient should be rescreened for risk of malnutrition regularly through hospital stay.Negative Predictive Value7,720 (True Negative)/7,720 (True Negative)+124 (False Negative)=98%Sensitivity1,568 (True Positive)/1,568 (True Positive)+124 (False Negative)=93%Specificity7,720 (True Negative)/7,720)(True Negative)+588 (False Positive)=93% Open table in a new tab Equally important to sensitivity and specificity are predictive values, which answer the questions: “if the test is positive, how likely is it that the patient has the disease?” (Positive Predictive Value [PPV]) or “how likely is it that the patient who tests negative for the disease is disease free?” (Negative Predictive Value [NPV]). This is particularly important when nutrition screening is done by a non-nutrition practitioner who alerts the RDN to at-risk patients. Depending on their confidence in the predictive value of the initial screening tool (and facility policy), RDNs may rescreen, by their own choice or based on department policy. For example, if the tool has a 50% PPV, only 50% of patients who are identified as at risk during screening will actually be malnourished when assessed by the RDN (increasing the number of patients in the upper right box [false positives] in Figure 2). This inaccuracy may cause the RDN to feel the need to rescreen to narrow the list of patients from a large group who were identified as at risk to those who are more likely to be at risk and, therefore, benefit from a consultation and medical nutrition therapy. Similarly, an RDN may need to rescreen when a tool with a low NPV is used because this tool may overlook patients at risk for malnutrition. The example from Figure 2 illustrates a tool with a high PPV and NPV. Therefore, RDNs using this tool can feel confident that their screening correctly identifies the patients who are in need of a complete assessment (ie, those who screen positive are likely to be malnourished and those who screen negative are unlikely to be malnourished). SGA is often used in studies as the gold standard (reference standard) when determining the validity of nutrition screening tools.24Ferguson M. Capra S. Bauer J. Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients.Nutrition. 1999; 15: 458-464Crossref PubMed Scopus (555) Google Scholar, 26Olivares J. Ayala L. Salas-Salvadó J. et al.Assessment of risk factors and test performance on malnutrition prevalence at admission using four different screening tools.Nutr Hosp. 2014; 29: 674-680PubMed Google Scholar Although SGA was originally developed as a screening tool to assess risk for poor surgical outcome,21Detsky A.S. McLaughlin J.R. Baker J.P. et al.What is subjective global assessment of nutritional status?.JPEN J Parenter Enteral Nutr. 1987; 11: 8-13Crossref PubMed Scopus (2266) Google Scholar it actually functions as a nutrition assessment tool. The SGA uses history (weight change, dietary intake change, gastrointestinal symptoms, functional capacity, diseases related to nutritional requirements) and physical exam (loss of subcutaneous fat, muscle wasting, edema, and ascites) to determine a patient’s nutritional status. Patients are diagnosed as well-nourished (A classification), moderately malnourished (B classification), or severely malnourished (C classification). Although SGA is a validated nutrition assessment tool across many disease states,27Steiber A. Leon J.B. Secker D. et al.Multicenter study of the validity and reliability of subjective global assessment in the hemodialysis population.J Renal Nutr. 2007; 17: 336-342Abstract Full Text Full Text PDF PubMed Scopus (121) Google Scholar, 28Sheean P.M. Peterson S.J. Gurka D.P. Braunschweig C.A. Nutrition assessment: The reproducibility of subjective global assessment in patients requiring mechanical ventilation.Eur J Clin Nutr. 2010; 64: 1358-1364Crossref PubMed Scopus (57) Google Scholar survey results of health-based professionals in the United States found that some providers continue to use this assessment tool for screening.7Patel V. Romano M. Corkins M.R. et al.Nutrition screening and assessment in hospitalized patients: A survey of current practice in the United States.Nutr in Clin Pract. 2014; 29: 483-490Crossref PubMed Scopus (64) Google Scholar, 23Anthony P.S. Nutrition screening tools for hospitalized patients.Nutr Clin Pract. 2008; 23: 373-382Crossref PubMed Scopus (159) Google Scholar Among adult hospitalized patients, SGA is an inappropriate nutrition screening tool for three reasons. First, screening, by definition, is the process of identifying patients who are at risk for malnutrition and would benefit from seeing an RDN. The scientific literature supports the validity of SGA to diagnose patients as well-nourished or malnourished (making a diagnosis rather than determining risk). Second, SGA requires gathering information from the medical chart, a patient interview, and a brief physical exam. Although it is not a lengthy tool, it does not meet the definition of simple, quick, and performed by any health professional without formal training in nutrition. Third, SGA is better at classifying patients as malnourished or well-nourished and is not sensitive enough to detect acute changes in nutritional risk usually found during the screening process.29Barbosa-Silva M. Cristina G. Barros A.J. Indications and limitations of the use of subjective global assessment in clinical practice: an update.Curr Opin Clin Nutr Metab Care. 2006; 9: 263-269Crossref PubMed Scopus (80) Google Scholar Screening methods vary substantially among facilities. To best use resources, only validated screening tools should be used. Using a validated tool may improve resource utilization by helping nutrition and dietetics practitioners feel more comfortable with other health professionals completing the screening step and thus decreasing double screening. Screening is not a one-time process but must be repeated throughout an admission because risk levels can change. Screening and assessment serve different and complimentary roles. The ultimate goal is to identify patients at risk for malnutrition and notify an RDN to complete a full assessment and diagnose malnutrition, if present. Lack of acceptance or understanding of nutrition screening by other health professionals could be due to differences in screening definitions across professions. According to the US Preventive Service Task Force, screening tests are defined as “those preventive services in which a test or standardized examination procedure is used to identify patients requiring special intervention”30US Preventive Services Task ForceGuide to Clinical Preventive Services.2nd ed. US Department of Health and Human Services, Office of Public Health and Science, Office of Disease Prevention and Health Promotion, Washington, DC1996Google Scholar (ie, procedures performed to detect disease in persons who have no symptoms or signs [are asymptomatic or pre-symptomatic]). However, this is usually not feasible in nutrition screening; rather, the clinician is looking for early signs and symptoms that a disease may be present. Consider the difference between screening for breast cancer, in which mammography is used to identify possible malignancies prior to the patient feeling any lumps, and screening for malnutrition, in which symptoms such as weight loss may already be present. In the future, nutrition may move closer to other medical professions as the use of presymptomatic biomarkers increases and advances. However, with the move toward asymptomatic identification of disease, the risk to those with false screening tests often increases, and care must be taken to ensure that earlier identification truly means better outcomes. Improving patient care and outcomes begins with identifying at-risk patients. RDNs can educate patients, families, administrators, and other health care practitioners about the goals and processes of valid nutrition screening to increase the provision of necessary dietetics services. The NCP supports this multidisciplinary approach to notify dietetics practitioners to provide appropriate intervention to improve patient outcomes, provide quality care, and decrease wasted resources." @default.
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