Joint actions to improve early recognition and treatment of malnutrition in the Netherlands;
from politics to science
Dutch PEN group: NESPEN – clinical nutrition and metabolism
c/o Cora F. Jonkers–Schuitema RD
Secretary NESPEN / AcademicMedicalCenter, Nutrition Support Team A0 115
PO box 22660NL 1100 DD AMSTERDAM
Phone: +3100 20 5665120,
Authors:Dutch Malnutrition Steering Group (DMG)*
Rationale
The Dutch Malnutrition steering Group (DMG) has beenfounded in 2005 to improve prevention, recognition and treatment of disease related malnutrition (DRM) in The Netherlands.
Methods
Members of the Dutch government were briefed, grants were applied and data on DRM were presented in the press and in scientific symposia.
Dutch Ministry of Health2006-2009 Implementation of screening and early treatment of malnutrition in Dutch Hospitals (hospital, outpatient clinic and paediatric wards)
Dutch Organisation for Health Research and Development & Nestlé Nutrition2008-2009 Development of the SNAQRC and implementation of screening and early treatment of malnutrition in residential care
Dutch Order of Medical Specialists 2009-2010Implementation workshops for paediatric wards
Dutch Ministry of Health2008-2011(Cost) effectiveness research and implementation of malnutrition screening and optimal treatment in primary and home care
Results
-DRM has becomean item in political debates and is defined as important care problem
-Mandatory screening of all patients (0-100 y) at hospitaladmission (fig 1) / twice a year in residential homes
-Protein and energy goals for malnourished hospitals patients are defined, and need to be reported on to the ministry of health 4 times/year
-A toolkit for implementation of screening and early optimal treatment for the hospital, outpatient, paediatric and residential care setting has been developed
-Development of a quick and easy screening tool for the primary and home care
-Costs of supplemental feeding is refunded by health insurance based on positive screeningSignificant decline in the prevalence of malnutrition in hospitals and home care organisations participating with LPZ project from 2004 until 2008 (fig 2)
Conclusion
Screening on malnutrition is now mandatory practice in all Dutch hospitalsand residential care homes and quality of nutritional treatment is measured systematically. This nationwide attention to malnutrition led to a gradual decline of the prevalence of malnutrition.
Future
Malnutrition will be one of the 4 topics of the National Safety Management Systemfor all Dutch hospitals. In residential care the DMGmalnutrition approach will be added to the national Quality of Care program. In primary andhome care early screening and treatment will be implemented and studied on (cost) effectiveness.
Figure 1 Percentage screening within 24 hours after hospital admission in 43 out of 50 hospitals involved in the DMG implementation project “Early recognition and treatment of malnutrition in Dutch hospitals”
Figure 2 Prevalence of disease related malnutrition in the Netherlands between 2004 and 2007 (from: Meijers JMM et al. Decreasing trends in malnutrition prevalence rates explained by regular audits and feedback.Journal of Nutrition 2009, in press)
*Authors
Projectmanagers and PhD studentsof the Dutch Malnutrition Steering Group
A Evers MLLRD, Projectmanager hospital, residential care, primary care and home care, Dutch Malnutrition Steering Group
E van der Heijden RD, PITactief, Trainers in education of health and nutrition, Manager Dutch Malnutrition Steering Group
HM Kruizenga PhD RD, VU University Medical Center Amsterdam, Department of Nutrition and Dietetics/ Projectmanager hospital, residential care, primary care and home care, Dutch Malnutrition Steering Group
E Leistra MSc, VU University Medical Center Amsterdam, Department of Nutrition and Dietetics; PhD student hospital project Dutch Malnutrition Steering Group
J Olieman PhD RD, Erasmus Medical Center Rotterdam, Department of Dietetics; Project manager paediatrics, Dutch Malnutrition Steering Group
J Schilp MSc, VU University Amsterdam, Department of Health Sciences; PhD student primary care and home care project, Dutch Malnutrition Steering Group
C van Wayenburg MSc MD, Nijmegen University Medical Center St Radboud, Department of General Practice, Projectmanager primary care and home care, Dutch Malnutrition Steering Group
Members of the Dutch Malnutrition Steering Group
W Arjaans RN, VU Medical University Center Amsterdam, Nurse Nutrition support team
F Bolle MScRN, Society of Nurses and Education in Care V&VN Utrecht
MAE van Bokhorst–de van der Schueren PhD RD, VU University Medical Center Amsterdam, Department of Nutrition and Dietetics
Prof. JJ van Binsbergen PhD MD, Nijmegen University Medical Center St Radboud, Department of General Practice
CF Jonkers–Schuitema RD, Academic Medical Center Amsterdam, DieticianNutrition support team, NESPEN
K Joosten PhD MD, ErasmusMedicalCenterRotterdam, Department of Paediatrics
Prof. H Kerkkamp PhD MD, AtriumMedicalCenterHeerlen, Board of Directors
Prof. PAM van Leeuwen PhD MD, VU University Medical Center Amsterdam, Surgery Department
H Maas MScMD, TweeSteden Ziekenhuis Tilburg, Geriatrics Department
Prof. EHM Mathus–Vliegen PhD MD, AcademicMedicalCenterAmsterdam, Department of Gastroenterology
Prof. CJJ Mulder PhD MD, VU UniversityMedicalCenterAmsterdam, Department of Gastroenterology / Chairman of Dutch Society of Gastroenterology and the Dutch Malnutrition Steering Group
W Remijnse RD, Dutch Dietetic Society, Policy consultant
Prof. HP Sauerwein PhD MD, MaastrichtUniversity, Department of Internal Medicine / Endocrinology
Prof. AMWJSchols PhD, MaastrichtUniversity, Department of Pulmonary Diseases
Prof. M VisserPhD, VU University Amsterdam, Department of Health Sciences, Nutrition and Health
Prof. JMGA Schols PhD MD, MaastrichtUniversity,Department of General Practice; Scientific Centre for Transformation in Care and WelfareTranzo, TilburgUniversity
Joint actions to improve early recognition and treatment of malnutrition in the Netherlands;
from politics to science