The Academy of Nutrition and Dietetics Foundation and dollars raised through its Second Century Member Campaign have supported significant research in the area of malnutrition, including The Academy and ASPEN Indicators to diagnose Malnutrition (AAIM) Validation and Optimal Staffing Study

Why is the AAIM study being conducted?

The lack of a systematic, universally accepted method of diagnosing malnutrition in hospitalized patients contributes to underdiagnosis, undertreatment, and poorer patient outcomes, as well as pushback from payers in reimbursing malnutrition care. Additionally, there are no evidence-based staffing equations linked to patient outcomes for use in hospital settings. The AAIM Study (previously known as the MCC Study) was initiated for two linked purposes: to validate a recommended set of indicators for diagnosing adult and pediatric malnutrition that were developed by the Academy and the American Society for Parenteral and Enteral Nutrition (ASPEN) using a consensus process and to develop and validate an equation for determining staffing requirements within a hospital setting.

The study will:

  • Establish the predictive validity of the adult and pediatric AAIM related to a portfolio of medical outcomes (e.g., length of stay, risk of mortality, severity of illness);
  • Examine the consistency with which registered dietitian nutritionists (RDNs) apply the AAIM criteria (inter-rater reliability); and
  • Quantify the amount of time required for RDNs to assess patients, diagnose malnutrition, and implement appropriate interventions to treat malnutrition, relative to improved patient medical outcomes.

Quantifying RDN time and effort, relative to patient outcomes, is important to justify changes to RDN staffing. “…[T]o develop a gold standard for an inpatient staffing model, we needed to provide evidence on the relationship of dietitian staffing to patient outcomes,” explains Barbara Isaacs Jordan, MS, RDN, CDN, Clinical Nutrition Management DPG Research Committee Co-chair. “Tying the validation of the ASPEN/Academy’s [indicators to diagnose malnutrition] to dietitian staffing will be a great accomplishment for the Academy.”

For more details on the study, check out the full study protocol in JAND (available here: JAND).

How can I contribute to the AAIM study?

The AAIM Study continues to recruit hospital sites – especially pediatric hospital sites. The study team is recruiting up to 60 adult and 60 pediatric hospitals. As of August 2021, there are approximately 100 hospitals involved in the AAIM study (52 adult sites and 42 pediatric sites; see Table).

Patients enrolled* Completed study

(# hospitals)

Collecting data

(# hospitals)

Preparing to start data collection

(# hospitals)

Completing study approval steps**

(# hospitals)

Adult hospitals 462 7 27 14 4
Pediatric hospitals 249 5 15 9 13

*goal: 600-1200 for different aspects of the study

**such as getting institutional review board approval and signing site agreement

 

There are still opportunities to contribute to the largest study ever undertaken by the Academy of Nutrition and Dietetics’ (Academy) Nutrition Research Network: The Academy and ASPEN Indicators to Diagnose Malnutrition (AAIM) Validation and Staffing Optimization Study.

It is important for the dietetics profession that the study be successfully completed, so please consider whether your hospital can participate. If you are interested in learning more about the study or if you would like to participate, please send an e-mail to the study team: aaim@eatright.org.

Our Foundation thanks the Commission on Dietetic Registration and the Pediatric Nutrition, Clinical Nutrition Management and the Renal Dietitians Practice Groups for their generous support of this project. Seca has also provided in-kind staff support and equipment for the bioelectrical impedance portion of the study.

Authors: Erin Lamers-Johnson, AAIM study coordinator, Academy of Nutrition and Dietetics; Elizabeth Yakes Jimenez, PhD, RDN, Director of the Nutrition Research Network, Academy of Nutrition and Dietetics; Julie Long, MS, MPH, RDN, CLC, AAIM study consultant; Alison Steiber, PhD, RDN, Chief Science Officer, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics; Beth Labrador, Development Director for the Academy of Nutrition and Dietetics Foundation.