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


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


METHODS
Intensive care units in Canada.


METHODS
Consecutive samples of mechanically ventilated patients at each time period.


METHODS
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.


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.
Jain
Minto K
MK
Department of Surgery, Queens University, USA.
Heyland
Daren
D
Dhaliwal
Rupinder
R
Day
Andrew G
AG
Drover
John
J
Keefe
Laurie
L
Gelula
Mark
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002170:Canada; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness; D003430:Cross-Sectional Studies; D004046:Dietetics / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D033181:Information Dissemination; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000592:standards*; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial
D001786:Blood Glucose