Dissemination of the Canadian clinical practice guidelines for nutrition support: results of a cluster randomized controlled trial.

Full Abstract

OBJECTIVE:
To compare the effectiveness of active to passive dissemination of the Canadian clinical practice guidelines (CPGs) for nutrition support for the mechanically ventilated critically ill adult patient.

DESIGN:
A cluster-randomized trial with a cross-sectional outcome assessment at baseline and 12 months later.

SETTING:
Intensive care units in Canada.

PATIENTS:
Consecutive samples of mechanically ventilated patients at each time period.

INTERVENTIONS:
In the active group, we provided multifaceted educational interventions including Web-based tools to dietitians. In the passive group, we mailed the CPGs to dietitians.

MEASUREMENTS AND MAIN RESULTS:
The primary end point of this study was nutritional adequacy of enteral nutrition; secondary end points measured were compliance with the CPGs, glycemic control, duration of stay in intensive care unit and hospital, and 28-day mortality. Fifty-eight sites were randomized. At baseline and follow-up, 623 and 612 patients were evaluated. Both groups were well matched in site and patient characteristics. Changes in enteral nutrition adequacy between the active and passive arms were similar (8.0% vs. 6.2 %, p = .54). Median time spent in the target glucose range increased 10.1% in the active compared with 1.8% in the passive group (p = .001). In the subgroup of medical patients, enteral nutrition adequacy improved more in the active arm compared with the passive group (by 8.1%, p = .04), whereas no such differences were observed in surgical patients. When groups were combined, during the year of dissemination activities, there was an increase in enteral nutrition adequacy (from 43% to 50%, p < .001), an increase in the use of feeding protocols (from 64% to 76%, p = .03), and a decrease in patients on parenteral nutrition (from 26% to 21%, p = .04). There were no differences in clinical outcomes between groups or across time periods.

CONCLUSIONS:
Although active dissemination of the CPGs did improve glycemic control, it did not change other nutrition practices or patient outcomes except in a subgroup of medical patients. Overall, dissemination of the CPGs improved other important nutrition support practices but was not associated with improvements in clinical outcomes.

Learn Faster Today Improve your study skills

Author information

Author/s: Jain, Minto K (MK); Heyland, Daren (D); Dhaliwal, Rupinder (R); Day, Andrew G (AG); Drover, John (J); Keefe, Laurie (L); Gelula, Mark (M);

Affiliation: Department of Surgery, Queens University, USA.

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

Journal: Critical care medicine (Crit Care Med), published in United States. (Language: eng)

Reference: 2006-Sep; vol 34 (issue 9) : pp 2362-9

Dates: Created 2006/08/21; Completed 2006/09/29; Revised 2007/11/15;

PMID: 16850001, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Associated Chemicals: Blood Glucose (0)

These are the highest related articles currently in the database:

See 100+ related articles.