6. In which health care settings can the PG-SGA© be used?

6. In which health care settings can the PG-SGA© be used?

The PG-SGA© has been used clinically in several settings – inpatient, outpatient, homecare, and hospice. The use of the same tool in all settings provides a consistent means of identifying patients with malnutrition and measuring outcomes of nutrition intervention as patients move through the spectrum of health care delivery systems. What is gained in each of these settings can be quite different but can have a positive impact on clinical outcomes and potentially healthcare costs.

► Inpatient: If the patient is hospitalized and has pre-existing weight loss on admission, it is important to think about intervention (nutritional and/or symptom management) rather than waiting until the patient has a complication or an extended hospitalization. Even more important, patient assessment should be carried out at diagnosis already, to be able to prevent nutritional status from further deterioration.

In 2003, Mobley et al., US Army, Walter Reed Medical Center, Washington DC (abstract ADA) reported that the PG-SGA© was the single best predictor of clinical outcomes in terms of length of stay for hospitalized medical, surgical or oncologic patients (n=63). Assessment were performed within 48 hours of admission and patients were followed until discharge.

Trained dietetic professionals performed a PG-SGA© with additional assessments including anthropometric measurements (height, weight, triceps skin fold and mid-arm circumference); calculation of Body Mass Index, percent usual body weight, percent desirable weight, and mid-arm muscle circumference; handgrip strength by hand dynamometry and standard laboratory values such as albumin, hematocrit, hemoglobin, blood urea nitrogen, and creatinine. Data were analyzed using stepwise multiple linear regression models (significance, P<0.05).

The results from this study indicated that PG-SGA© is the single best predictor of length of stay and the authors suggested that based on the findings from the study that the PG-SGA© may be a valuable screening tool to identify those patients who may require intensive medical nutrition therapy, especially in hospital settings where laboratory data is limited and/or unavailable. Additionally, that early nutritional intervention in those patients with increased PG-SGA scores may lead to better clinical outcomes.

The relationship between the PG-SGA© and clinical outcome, as well as quality of life has been confirmed in several studies thereafter (e.g. Bauer et al., 2002; Isenring et al., 2003; Campbell et al., 2008; Shahmoradi et al., 2009; Laky et al., 2010; Capuano et al., 2010; Zalina et al., 2012; Esfahani et al., 2013; Citak et al., 2013; Malihi et al., 2013; Mohammadi et al., 2013).

► Outpatient: This has been widely used as a method of streamlining patient flow through clinic with the benefit of efficient and consistent assessment of weight and weight history; food intake; symptoms (often referred to as nutrition impact symptoms) and functionality of performance status). In many clinics that patient completes the PG-SGA© while in the waiting room or patient room, with the medical team able to spend their limited time spent with the patient addressing the identified issues rather than spending the time asking questions.

► Homecare: The same benefits can be achieved in this setting but also may help to either identify at risk patients, or help to transition from hightech (parenteral or enteral) nutrition to oral.

► Hospice: Particularly important is the aspects of standardized, patient self-reported symptoms and quality of life in the context of functionality, weight and nutrition.