title: Implementation of a computerized system in pediatric wards to improve nutritional care: a cluster randomized trial.
abstract: OBJECTIVE
  Malnutrition occurs frequently in hospitalized children. We aimed to assess whether a computerized system could lead to improved clinical practices in malnourished children.
  
  
  METHODS
  Healthcare workers (242) from six departments in a pediatric university hospital participated in a cluster randomized trial, studying 1457 malnourished children hospitalized from September 2009 to August 2011. Following a baseline observational pre-intervention period, all departments were randomized into either intervention or control arms. A computerized malnutrition-screening system was implemented in the intervention group to automatically trigger a dietetic referral in real time. Furthermore, the nutrition support team conducted an awareness campaign with healthcare workers and a leadership-based strategy to reinforce the message during the entire study period. Adherence to practice guidelines (daily weights, investigation of etiology for malnutrition, management by a dietitian and application of refeeding protocols) was compared between pre- and post-intervention periods in both the intervention and trial arms.
  
  
  RESULTS
  When compared with the pre-intervention period, the clinical practices were significantly improved within the intervention arm for every outcome (P<0.01), whereas remained unchanged in the control arm. In addition, during the post-intervention period, malnutrition etiology investigation by physicians (adjusted odds ratio (OR) of 4.4, 95% confidence interval (CI) 1.7-11.8, P=0.003) and management by a dietitian (OR 2.7, 95% CI 1.0-6.9, P=0.046) occurred more frequently in the intervention clusters.
  
  
  CONCLUSIONS
  Implementation of an electronic system to detect malnutrition in real time was associated with a rapid improvement in clinical practices for better care of hospitalized children.
authors: 1] Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France [2] Université de Lyon, EA Santé-Individu-Société 4129, Lyon, France [3] Medical School Lyon Est, Université Claude Bernard Lyon1, Lyon, France.
authors: A
authors: A
authors: Duclos
authors: 1] Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France [2] Université de Lyon, EA Santé-Individu-Société 4129, Lyon, France.
authors: S
authors: S
authors: Touzet
authors: Paediatric Nutrition Unit, Hospices Civils de Lyon, Bron, France.
authors: L
authors: L
authors: Restier
authors: 1] Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France [2] Medical School Lyon Est, Université Claude Bernard Lyon1, Lyon, France.
authors: P
authors: P
authors: Occelli
authors: 1] Paediatric Nutrition Unit, Hospices Civils de Lyon, Bron, France [2] INSERM CIC201, Service de Pharmacologie Clinique, EPICIME, Hospices Civils de Lyon, Bron, France.
authors: F
authors: F
authors: Cour-Andlauer
authors: Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France.
authors: A
authors: A
authors: Denis
authors: Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France.
authors: S
authors: S
authors: Polazzi
authors: 1] Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France [2] Université de Lyon, EA Santé-Individu-Société 4129, Lyon, France [3] Medical School Lyon Est, Université Claude Bernard Lyon1, Lyon, France.
authors: C
authors: C
authors: Colin
authors: 1] Medical School Lyon Est, Université Claude Bernard Lyon1, Lyon, France [2] Paediatric Nutrition Unit, Hospices Civils de Lyon, Bron, France [3] CarMEN Laboratory U1060, INSERM, Lyon, France.
authors: A
authors: A
authors: Lachaux
authors: 1] Medical School Lyon Est, Université Claude Bernard Lyon1, Lyon, France [2] Paediatric Nutrition Unit, Hospices Civils de Lyon, Bron, France [3] CarMEN Laboratory U1060, INSERM, Lyon, France.
authors: N
authors: N
authors: Peretti
mesh_terms: D000293:Adolescent; D002648:Child; D015362:Child Nutrition Disorders / Q000175:diagnosis* / Q000178:diet therapy / Q000453:epidemiology / Q000209:etiology; D002675:Child, Preschool; D016000:Cluster Analysis; D003936:Diagnosis, Computer-Assisted; D004045:Dietary Services; D005240:Feasibility Studies; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006284:Health Plan Implementation; D006757:Hospital Units; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007318:Inservice Training; D008297:Male; D015596:Nutrition Assessment; D010372:Pediatrics / Q000379:methods*; D015995:Prevalence; D012017:Referral and Consultation; D000078329:Workforce
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