Nutricion

Nutrition Care Process and Model: ADA adopts road
map to quality care and outcomes management
KAREN LACEY, MS, RD; ELLEN PRITCHETT, RD
The establishment and implementation of a standardized
Nutrition Care Process (NCP) and Model were identified as
priority actions for the profession for meeting goals of the
ADA Strategic Plan to “Increase demand and utilization of services
provided bymembers” and “Empower members to compete
successfully in a rapidly changing environment” (1). Providing
high-quality nutrition care means doing the right thing at
the right time, in the right way, for the right person, and achieving
the best possible results. Quality improvement literature
shows that, when a standardized process is implemented, less
variation and more predictability in terms ofoutcomes occur
(2). When providers of care, no matter their location, use a
process consistently, comparable outcomes data can be generated
to demonstrate value. A standardized Nutrition Care Process
effectively promotes the dietetics professional as the
unique provider of nutrition care when it is consistently used as
a systematic method to think critically and make decisions to
providesafe and effective nutrition care (3).
This article describes the four steps of ADA’s Nutrition Care
Process and the overarching framework of the Nutrition Care
Model that illustrates the context within which the Nutrition
Care Process occurs. In addition, this article provides the rationale
for a standardized process by which nutrition care is provided,
distinguishes between the NutritionCare Process and
Medical Nutrition Therapy (MNT), and discusses future implications
for the profession.
BACKGROUND
Prior to the adoption of this standardized Nutrition Care Process,
a variety of nutrition care processes were utilized by practitioners
and taught by dietetics educators. Other allied health
professionals, including nursing, physical therapy, and occupational
therapy, utilizedefined care processes specific to their
profession (4-6). When asked whether ADA should develop a
standardized Nutrition Care Process, dietetics professionals
were overwhelmingly in favor and strongly supportive of having
a standardized Nutrition Care Process for use by registered
dietitians (RD) and dietetics technicians, registered (DTR).
The Quality Management Committee of the House ofDelegates
(HOD) appointed a Nutrition Care Model Workgroup in
May 2002 to develop a nutrition care process and model. The
first draft was presented to the HOD for member input and
review in September 2002. Further discussion occurred during
the October 2002 HOD meeting, in Philadelphia. Revisions
were made accordingly, and the HOD unanimously adopted the
final version of the Nutrition CareProcess and Model on March
31, 2003 “for implementation and dissemination to the dietetics
profession and the Association for the enhancement of the
practice of dietetics.”
SETTING THE STAGE
Definition of Quality/Rationale for a Standardized
Process
The National Academy of Science’s (NAS) Institute of Medicine
(IOM) has defined quality as “The degree to which health
services for individualsand populations increase the likelihood
of desired health outcomes and are consistent with current
professional knowledge” (7,8). The quality performance of providers
can be assessed by measuring the following: (a) their
patients’ outcomes (end-results) or (b) the degree to which
providers adhere to an accepted care process (7,8). The Committee
on Quality of Health Care in America furtherstates that
it is not acceptable to have a wide quality chasm, or a gap,
between actual and best possible performance (9). In an effort
to ensure that dietetics professionals can meet both requirements
for quality performance noted above, the American Dietetic
Association (ADA) supports a standardized Nutrition
Care Process for the profession.
Standardized Process versus Standardized Care...