Jane V. White

Consensus Statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition)

The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutritions incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutritions recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutritions prevention and treatment and further ensure the provision of high-quality, cost-effective nutrition care.

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)

The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutritions incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutritions recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutritions prevention and treatment, and further ensure the provision of high quality, cost effective nutritional care.

Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators Recommended for the Identification and Documentation of Pediatric Malnutrition (Undernutrition)

The Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), utilizing an evidence-informed, consensus-derived process, recommend that a standardized set of diagnostic indicators be used to identify and document pediatric malnutrition (undernutrition) in routine clinical practice. The recommended indicators include z scores for weight-for-height/length, body mass index-for-age, or length/height-for-age or mid-upper arm circumference when a single data point is available. When 2 or more data points are available, indicators may also include weight gain velocity (<2 years of age), weight loss (2-20 years of age), deceleration in weight for length/height z score, and inadequate nutrient intake. The purpose of this consensus statement is to identify a basic set of indicators that can be used to diagnose and document undernutrition in the pediatric population ages 1 month to 18 years. The indicators are intended for use in multiple settings (eg, acute, ambulatory care/outpatient, residential care). Several screening tools have been developed for use in hospitalized children. However, identifying criteria for use in screening for nutritional risk is not the purpose of this paper. Clinicians should use as many data points as available to identify and document the presence of malnutrition. The universal use of a single set of diagnostic parameters will expedite the recognition of pediatric undernutrition, lead to the development of more accurate estimates of its prevalence and incidence, direct interventions, and promote improved outcomes. A standardized diagnostic approach will also inform the prediction of the human and financial responsibilities and costs associated with the prevention and treatment of undernutrition in this vulnerable population and help to further ensure the provision of high-quality, cost-effective nutritional care.

Position of the American dietetic association: Nutrition — an essential component of medical education

Abstract The public is increasingly nutrition conscious and actively seeks reliable sources of nutrition education. Physicians with appropriate training in nutrition can and should be a powerful force in providing accurate nutrition information and quality health care. As physician educators, dietetics professionals can facilitate this outcome. Appropriate use of nutrition resources and professionals will efficiently and effectively maintain or improve the nutritional status of the public and, ultimately, the health of our nation.

Nutrition care of older adults with chronic disease: attitudes and practices of physicians and patients.

Objectives: Eighty percent of older adults have at least one chronic disease. Most conditions could be improved with nutritional intervention. This scientific study assessed physician and patient knowledge of, and behaviors about nutrition, resulting in tools to guide physicians in nutrition management of chronic diseases. Methods: Surveys were conducted of 300 practicing physicians and 600 older adults to identify current attitudes and practices regarding the role of nutrition in chronic disease management. Results: Ninety percent of physicians surveyed recognize the relationship between nutrition and chronic disease. Yet nutrition care occurs only sporadically in primary care settings. Conclusions: Most physicians are aware of nutrition in managing chronic disease, but a significant percentage do not routinely include nutrition in their practice. This research led to the development of tools to assist in identifying and managing the nutritional aspects of chronic disease.

Invited Review: The Nutrition Screening Initiative: A 5-Year Perspective:

A history of the goals, activities, and accomplishments of the Nutrition Screening Initiative (NSI) is provided. A commentary on the development and intended use of the NSIs self-assessment and screening tools is given to facilitate selection of feeding devices for older Americans who need nutrition care. Additional questionnaires and interventions designed to address the needs identified through the NSIs standardized, interdisciplinary approach to the assessment of nutritional risk are described and their use encouraged. Legislative and public policy advocacy is summarized. A systemic approach to the assessment and maintenance of optimal nutritional health in the older population will have a profound effect on health care delivery systems.

Beyond nutrition screening: A systems approach to nutrition intervention ☆: Challenges and opportunities for dietetics professionals

Abstract Malnutrition in older Americans involves many disparate and complex causes. Dietetics professionals need to broaden their scope of practice in dealing with nutrition screening and intervention themselves and in providing expert consultation to others. Health and social services generalists such as physicians, nurses, and social workers must become more aware of the presence and risk of nutrition-related problems in the elderly and must adopt a systematic, collaborative approach to their solution. Nutrition screening, intervention, appropriate referral, and consultation must be built into daily practice. The NSI is a challenge and a call to action for all dietetics professionals. Registered dietitians must become active participants on interdisciplinary teams. They must assume a leadership role in areas of nutrition screening, assessment, and intervention. Their knowledge, skills, and expertise must continue to keep pace not only with advances in the science and technology of nutrition but also with relevant areas of related fields. The tools provided by the NSI and partnerships between nutrition and other health and social services professionals provide opportunity for the widespread incorporation of a systematic approach to delivery of nutrition services. Attention to nutritional health is too important to be left solely to health specialists or to generalists; all must become active participants in maximizing the nutritional health of older Americans.

Elements of Ethical Billing for Nutrition Professionals

T HE PROVISION OF CLINICAL nutrition services is a core activity within the profession of dietetics. It isnotonlythedietetics practitioners who provide the clinical nutrition service that must understand and comply with sound business and ethical billing practices; those who provide one or more of the myriad of food, administrative, community, education, and/or research components that support and augment reimbursable services, includingbillers, mustalsoknowandadheretotheelementsof ethical billing across the continuum of both practice management and the delivery of clinical nutrition care (1) (Codeof Ethics Principles 1, 2, 4). The Code of Ethics is designed to ensure competent, values-based practice (1). It should not be used to resolve business or practice disputes between dietetics practitioners, other health care providers, and/or consumers (2). Poor business practices are associated with the multiple “losses”: loss of brandandprofessional reputation, loss of customers, employees, revenue, and in the end, loss of thebusiness itself. Business/contract disputes are not automatically Code of Ethics violations, but may often result from poor business practices, unprofessional be-

White Paper AGA: An Episode-of-Care Framework for the Management of Obesity—Moving Toward High Value, High Quality Care: A Report From the American Gastroenterological Association Institute Obesity Episode of Care and Bundle Initiative Work Group

&NA; The American Gastroenterological Association acknowledges the need for gastroenterologists to participate in and provide value‐based care for both cognitive and procedural conditions. Episodes of care are designed to engage specialists in the movement toward fee for value, while facilitating improved outcomes and patient experience and a reduction in unnecessary services and overall costs. The episode of care model puts the patient at the center of all activity related to their particular diagnosis, procedure, or health care event, rather than on a physician’s specific services. It encourages and incents communication, collaboration, and coordination across the full continuum of care and creates accountability for the patient’s entire experience and outcome. This paper outlines a collaborative approach involving multiple stakeholders for gastrointestinal practices to assess their ability to participate in and implement an episode of care for obesity and understand the essentials of coding and billing for these services.

Nutrition in Chronic Disease Management in the Elderly

Older Americans experience chronic disease at rates well above other segments of our society. Rates of health services use are also 2 to 3 times that of younger age groups. The most rapidly growing segments of Americas aging population are also its most nutritionally vulnerable-women, minorities, and those 85 years of age and older. The routine incorporation of nutrition screening and intervention into chronic disease management protocols will lower healthcare services usage, decrease healthcare costs, help relieve the burden of human suffering experienced by older Americans with chronic disease, and improve quality of life for our nations elders.