Ariculo

OF PROFESSIONAL INTEREST

Nutrition Care Process and Model: ADA adopts road
map to quality care and outcomes management
KAREN LACEY, MS, RD; ELLEN PRITCHETT, RD

he 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 utilizationof services provided by members” 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 morepredictability in terms of outcomes 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 makedecisions to
provide safe 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, distinguishesbetween the Nutrition Care Process and
Medical Nutrition Therapy (MNT), and discusses future implications for the profession.

T

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
K. Lacey is lecturer and Director of Dietetic Programs
at theUniversity of Wisconsin-Green Bay, Green Bay. She
is also the Chair of the Quality Management Committee.
E. Pritchett is Director, Quality and Outcomes at ADA
headquarters in Chicago, IL.
If you have questions regarding the Nutrition Care Process and Model, please contact Ellen Pritchett, RD, CPHQ,
Director of Quality and Outcomes at ADA,
epritchett@eatright.org
Copyright © 2003 by theAmerican Dietetic Association.
0002-8223/03/10308-0014$35.00/0
doi: 10.1053/jada.2003.50564

professionals, including nursing, physical therapy, and occupational therapy, utilize defined 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 havinga standardized Nutrition Care Process for use by registered
dietitians (RD) and dietetics technicians, registered (DTR).
The Quality Management Committee of the House of Delegates (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 discussionoccurred during
the October 2002 HOD meeting, in Philadelphia. Revisions
were made accordingly, and the HOD unanimously adopted the
final version of the Nutrition Care Process 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 fora Standardized
Process
The National Academy of Science’s (NAS) Institute of Medicine (IOM) has defined quality as “The degree to which health
services for individuals and 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...