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February 28, 2019


Research Published in International Journal Publication

March 1, 2019


Research Published in International Journal Publication

APPLETON, Wis. – Members of the Dietitian Services team at ThedaCare Regional Medical Centers-Appleton and Neenah were recently featured, along with their colleagues, in an international journal publication.

The study, which was led by ThedaCare, focuses on screenings to help determine patients with and at risk for malnutrition. The work was published in the January issue of the Journal of Parenteral and Enteral Nutrition.

“For people in our community, it helps us identify if they have malnutrition and intervene,” explained Lori Hartz MS, RDN, CD, Manager of Dietitian Services and OP Nutrition and Diabetes Education and one of the authors of the study. “If we can improve nutritional status, we can possibly change the course of their disease. It seems pretty basic, but when you’re sick, you need those calories and nutrition to heal.”

Hartz along with Cheryl Shockey, Lead for Dietitian Services at ThedaCare, were involved with the research. They were joined by Bridget M. Stroup, PhD, RDN, CD2 with the University of Wisconsin-Madison, Tracy A. Bibelnieks, PhD3, with the University of Minnesota-Duluth and Denise M. Ney, PhD, RDN, CD2, with University of Wisconsin-Madison.

“We compared the Nutrition Risk Screen (NRS) 2002, which is the current validated NRS cited in the literature for hospitalized patients with our screen,” said Hartz. “Because the NRS 2002 screen misses patient with malnutrition, we developed our own screen using the Plan-Do-Study-Act (PDSA) methodology”

The Joint Commission on Accreditation of Healthcare Organizations requires that patients are screened for risk of malnutrition within 24 hours of being admitted to the hospital. According to Hartz, malnutrition in patients can increase the length of stay, readmissions and mortality.

“Because malnutrition is highly correlated with mortality, it is important to treat early, and/or determine the patient’s quality of life wishes, so we use nutrition intervention to improve their disease outcome,” said Hartz.

To conduct the research, the team enrolled in a national clinic trial which lasted about nine months. They used the NRS 2002 and ThedaCare NRS for nearly 600 patients at hospitals in the non–intensive care unit setting. They determined if a patient had malnutrition or was at risk for malnutrition using guidelines established by the American Society of Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics.

Here are some of the results from the research:        

  • ThedaCare NRS had higher sensitivity (98.8% vs 63.5%), when compared to NRS 2002.  Meaning 98.8% of patients with malnutrition were identified accurately by the ThedaCare NRS.
  • The ThedaCare NRS had a high agreement of reproducibility of diagnosis outcome than the NRS 2002, regardless of who administered the screen.
  • The ThedaCare NRS required less time to complete when compared with the NRS 2002. The ThedaCare NRS takes 17 seconds vs nine minutes to complete for the NSR 2002.

Hartz said the study took a team effort from the organization, including dietitians and dietetic technicians, nursing, clinical documentation improvement specialists (CDI), coders, decision resources, and support from administration. Hartz said they are grateful to have worked with Professor Denise Ney and Bridget Stroup from the Department of Nutritional Science at UW-Madison and Dr. Tracy Bibelnieks, professor in the Department of Mathematics and Statistics at UM-Duluth.

“Sometimes what is published as best practice was at one time. As we continually improve our understanding of healthcare, our previous best practice becomes obsolete,” said Hartz. “It is important for clinicians working in the field to be able to conduct research studies to compare and contrast so we can continue to evolve how we can most efficiently and effectively take care of our patients. I’m proud of the results we accomplished together.”

Hartz explains the results from this research will continue to be used in future learning opportunities regarding nutrition.

About ThedaCare

For more than 110 years, ThedaCare® has been committed to finding a better way to deliver serious and complex healthcare to patients throughout Northeast and Central Wisconsin. The organization serves a community of more than 600,000 residents and employs more than 6,700 healthcare professionals throughout the regions. ThedaCare has seven hospitals located in Appleton, Neenah, Berlin, Waupaca, Shawano, New London and Wild Rose as well as 31 clinics in nine counties. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care Network Member, giving our specialists the ability to consult with Mayo Clinic experts on a patient’s care. ThedaCare is a non-profit healthcare organization with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs as well as a foundation dedicated to community service.

For more information, visit or follow ThedaCare on Facebook and Twitter.

Media should call Cassandra Wallace, Public Relations Specialist at 920.442.0328 or the ThedaCare Regional Medical Center-Neenah switchboard at 920.729.3100 and ask for the marketing person on call.