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Nutritional Epidemiology

Decreasing Trends in Malnutrition Prevalence Rates Explained by Regular Audits and Feedback^1,2

³ Department of Health Care and Nursing Science, Maastricht University, Maastricht 6200 MD, The Netherlands ⁴ Department of Methodology and Statistics, Maastricht University, Maastricht 6200 MD, The Netherlands ⁵ Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht 6200 MD, The Netherlands ⁶ Tranzo Department, Tilburg University, Tilburg 5000 LE, The Netherlands ⁷ Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam 1007 MB, The Netherlands

To our knowledge, no studies have analyzed the influence of annual audit and feedback on the prevalence rates of malnutrition. This study analyzes the trend of malnutrition prevalence rates between 2004 and 2007 and the effects of previous audits and feedback from the annual Dutch National Prevalence Measurement of Care Problems (LPZ) and the effect of the participation in Dutch national improvement programs. From 2004 to 2007, an annual multicenter study was performed in Dutch hospitals, nursing homes, and home care organizations using a standardized questionnaire involving measurements at institutional, ward, and patient levels. The data were analyzed by logistic multilevel analysis. Nutritional status was assessed by BMI, undesired weight loss, and nutritional intake. In total, 80 hospitals, 141 nursing homes, and 48 home care organizations participated. The prevalence of malnutrition tended to decrease in hospitals and home care over the years. In nursing homes, prevalence rates were stable. Furthermore, the more often hospitals and home care organizations participated in the annual LPZ audits, the lower the prevalence rate of malnutrition (P < 0.001). Participation in national improvement programs also resulted in lower prevalence rates (P = 0.027). In conclusion, malnutrition prevalence rates have decreased over the last 4 y in hospitals and home care in The Netherlands. Participation in the LPZ and involvement in national improvement programs positively influenced these malnutrition prevalence rates, possibly indicating that increasing awareness and actively working toward improvement could be important in lowering these rates.

^* To whom correspondence should be addressed. E-mail: j.meijers{at}zw.unimaas.nl.

Manuscript received 20 November 2008. Initial review completed 12 January 2009. Revision accepted 15 May 2009.