title: Training Nonnursing Staff to Assist with Nutritional Care Delivery in Nursing Homes: A Cost-Effectiveness Analysis.
abstract: OBJECTIVE
  To determine the effect and cost-effectiveness of training nonnursing staff to provide feeding assistance for nutritionally at-risk nursing home (NH) residents.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  Five community NHs.
  
  
  METHODS
  Long-stay NH residents with an order for caloric supplementation (N = 122).
  
  
  METHODS
  Research staff provided an 8-hour training curriculum to nonnursing staff. Trained staff were assigned to between-meal supplement or snack delivery for the intervention group; the control group received usual care.
  
  
  METHODS
  Research staff used standardized observations and weighed-intake methods to measure frequency of between-meal delivery, staff assistance time, and resident caloric intake.
  
  
  RESULTS
  Fifty staff (mean 10 per site) completed training. The intervention had a significant effect on between-meal caloric intake (F = 56.29, P < .001), with the intervention group consuming, on average, 163.33 (95% CI = 120.19-206.47) calories per person per day more than the usual care control group. The intervention costs were $1.27 per person per day higher than usual care (P < .001). The incremental cost-effectiveness ratio for the intervention was 134 kcal per dollar. The increase in cost was due to the higher frequency and number of snack items given per person per day and the associated staff time to provide assistance.
  
  
  CONCLUSIONS
  It is cost effective to train nonnursing staff to provide caloric supplementation, and this practice has a positive effect on residents' between-meal intake.
authors.affiliation: Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee.|Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Center for Quality Aging, Nashville, Tennessee.|Geriatric Research, Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
authors.affiliation: Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Center for Quality Aging, Nashville, Tennessee.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Hollingsworth
authors.affiliation: Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Center for Quality Aging, Nashville, Tennessee.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Long
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
authors.forename: Xulei
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Shotwell
authors.affiliation: Rand Corporation, Santa Monica, California.
authors.forename: Emmett
authors.initials: E
authors.lastname: Keeler
authors.affiliation: Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois.
authors.forename: Ruopeng
authors.initials: R
authors.lastname: An
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Silver
mesh_terms: D000369:Aged, 80 and over; D001835:Body Weight; D003362:Cost-Benefit Analysis; D004035:Diet Therapy; D002149:Energy Intake; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007318:Inservice Training; D008297:Male; D044342:Malnutrition / Q000517:prevention & control; D009735:Nursing Homes; D015397:Program Evaluation
keywords: feeding assistant regulation; long-term care; staff training; unintentional weight loss