Top-down and bottom-up approach of malnutrition leads to a decrease in malnutrition prevalence rates

in all health care settings in the Netherlands

M. van Bokhorst - de van der Schueren, C. Jonkers - Schuitema, H. Kruizenga, A. Evers, E. van der Heijden, E. Leistra, J. Schilp, J. Meijers, R. Halfens, J. Schols,

K. Joosten, G. Wanten, C. Mulder

2004

• LPZ (annual measurement of care problems)

cross-sectional measurements of malnutrition across all health-care setting in the Netherlands, n ~30.000 patients per year

• Multidisciplinary Steering Group

(involving all disciplines as well as associations of specialists and hospital boards)

lobbies the Ministry of Health to raise attention to the ongoing problem of disease related malnutrition in Dutch health care

2006

• Dutch Malnutrition Steering Group receives political endorsement and convinces Ministry of Health to support development of screening and treatment tools for hospitals, residential care and community

• From 2006 the Ministry of Health is fully involved and funds the projects of the Dutch Malnutrition Steering Group from 2006-2012 (€ 1.5 billion)

Ministry of Health:

- Financing

- Nutrition report: The view on health and prevention

- Mandatory screening and measurement of treatment

Toolkits: (development, testing, implementation with the field)

Continuous internal and external audits and feedback on malnutrition prevalence, screening and treatment

Bottom-up Top-down

Provision of instruments, website and half-products

Data collection

The Dutch approach

Annual prevalence measurement

Screening instruments, toolkits, website

Training programmes

Mandatory screening

Mandatory reports on treatment

2004

2006

2005

2007

2008

2009

2010

Hospitals

Nursing homes

Home care

SNAQ RC

SNAQ 65+

2011

60% participation

Annual report to Healthcare Inspectorate

Annual report to Healthcare Insp.

~30,000

patients

per year

SNAQ, MUST, STRONGkids, growth analyzer

Annual report

Annual report

Experiments leading to best practices

Website per healthcare setting

Pocket booklet

Multidisciplinary guidelines

Results at national level

Steady decrease in malnutrition prevalence rates

15,0

17,0

19,0

21,0

23,0

25,0

27,0

29,0

31,0

33,0

2004 2005 2006 2007 2008 2009

hospitalCare homesHome care

Key achievements

• Mandatory screening and treatment in all health-care settings

• Ongoing collection and feedback of malnutrition data

• Malnutrition in main list of quality indicators in Dutch health care

• Protein and energy goals for malnourished patients defined

• Recognition of malnutrition as a healthcare problem as important as obesity

• Malnutrition defined as one of the four topics in the National Safety Management System for all Dutch hospitals

• (Risk of) malnutrition has become an official indication for reimbursement of medical nutrition in the basic health insurance

Key success factors

• LPZ (annual measurement of care problems) and Dutch Malnutrition Steering Group

• Multidisciplinary approach

• Involvement of Ministry of Health

• Mandatory screening in all health care settings

• Mandatory reporting on optimal treatment in hospitals

• Interactive website and ready-to-use products

• Toolkits to enhance implementation

• Large numbers of training programmes and workshops

Future plans

• Annual measurement and further implementation of screening and treatment in all health care settings

• Improvement of results

• Sharing knowledge and experience in Europe and website in English

• Strengthening the chain

• A Ministry-funded “Malnutrition Knowledge Center”

• Improvement in the basic education of (clinical) nutrition for doctors and nurses

Ellen van der Heijden, RD Hinke Kruizenga, PhD RD Anja Evers, RD LLM Chris Mulder, PhD MD

coordinator DMG project leader DMG project leader DMG president DMG

Cora Jonkers - Schuitema, RD Koen Joosten, PhD MD Geert Wanten, PhD MD Eva Leistra, MSc secretary NESPEN & DMG NESPEN & DMG president NESPEN PhD student DMG

Ruud Halfens PhD RN Jos Schols, PhD MD Judith Meijers, PhD RN Janneke Schilp, MSc

LPZ LPZ & DMG LPZ PhD student DMG

... and all other researchers, dietitians, dietetic assistants, nurses, physicians, policy makers, patients, ...