Evaluation and Implementation of Malnutrition Screening tools in dental settings

Project Summary/Abstract Tooth loss is still a public health concern, and it affects daily oral functions thereby impacting general health. Even though tooth loss can be rehabilitated through dentures, chewing efficiency declines compared to natural dentition, affecting one’s nutritional intake. Individuals who have lost all their teeth or partially dentate with and without prostheses are known to be at risk for malnutrition. As a result, it is essential to monitor their nutritional profile among adults experiencing edentulousness and receiving prosthodontic treatments. However, this is not a common procedure during dental visits. Although, many malnutrition screening (MS) tools exist in general health settings they are not used in dental practices because of lack of evidence for the tools’ performance, on the usability, and lack of understanding of patient outcomes among individuals with dentures. The long-term goal for our proposed research study is to facilitate a patient-centered healthcare system by translating the best scientific evidence into clinical practice through clinical decision support systems (CDSS), especially those that emphasize continuity of care between dental and other healthcare providers. The objective of this career development award is to evaluate the accuracy and performance of the three malnutrition screening tools, Nutrition Screening Initiative (NSI), Mini Nutritional Assessment-Short Form (MNA-SF), and Malnutrition Screening Tool (MST), and use them to screen and refer to a clinical registered dietitian, and to evaluate the feasibility of the tools’ implementation in dental practices. The rationale for this proposed work is to identify and refer denture-wearing patients at risk for malnutrition, and to reduce the risk for experiencing adverse effects of malnutrition which would compromise their quality of life. To accomplish the goal, I propose the following three specific aims: 1) Evaluate the usability of three MS tools with end users (denture wearers) and assess the tools’ accuracy in identifying malnutrition risk by comparing their results to a gold standard: a registered dietitian’s nutritional assessment. 2) Determine dental clinicians’ opinions of the three malnutrition screening tools and their perceived facilitators and barriers to implementing these tools in dental practices. Focus groups with DCs will collect information on their perspectives, opinions, knowledge, attitudes, and recommendations on using the MS tool for clinical decision-making by using the consolidated framework for implementation research (CFIR). 3) Evaluate the feasibility and effectiveness of implementing in dental practices the three malnutrition screening tools for screening and referring patients who receive/wear dentures. Iterative usability testing with denture wearers, clinicians, and contextual inquiry (CI) observations in dental practices will be used to understand the ease in use of the tool by the end user within the clinical workflow. The outcome of this research is to provide scientific evidence on the effectiveness of using malnutrition risk screening with denture wearers in dental practices. The proposed work will inform on the design and implementation of MS tools.