©2006 American Dietetic Association
Disorders of Lipid Metabolism Toolkit
OUTCOMES MANAGEMENT: NUTRITION MONITORING AND
EVALUATION
Nutrition Monitoring and Evaluation is the fourth step of the Nutrition Care Process
Monitoring is defined as the review and measurement of the patient/client/group’s status
at preplanned, scheduled follow-up time points with regard to the prior three steps of
nutrition assessment, nutrition diagnosis, and nutrition interventions. Evaluation is
defined as the systematic comparison of subsequent findings with initial status,
intervention goals, or a reference standard and evaluates progress in achieving outcomes.
Whereas, Outcomes Management involves use of a system that evaluates the
effectiveness and efficiency of the entire nutrition care process (assessment, diagnosis,
interventions, cost, and others).
Outcomes Management Encompasses Three Components:
 Outcomes measurement: the systematic quantification, at a single point in time, of
outcome indicators. Outcome indicators are selected that are relevant to the
nutrition diagnosis or signs or symptoms, nutrition interventions and goals, and
quality management goals.
 Outcomes monitoring: repeated measurement of outcome indicators over time to
support casual inferences about how the outcomes were produced. It provides
evidence that the intervention strategy is or is not changing patient/client/group
status or behavior and identifies both positive and negative outcomes.
 Outcomes management: use of information gained from monitoring care to
achieve optimal outcomes through improved clinical decision making and
delivery of quality of care.
Why Monitor Outcomes?
The purpose of monitoring and evaluating outcomes is to determine the degree to which
progress is being made and desired outcomes of nutrition care goals are being met. Data
from monitoring and evaluating outcomes can then be used to create an outcomes
management system.
Documentation and demonstration of patient/client/group outcomes is essential in all
settings. Clinicians use the outcomes of medical nutrition therapy (MNT) to guide the
treatment process, by comparing outcomes achieved with those anticipated. Pooled and
aggregated data summarize the results of protocol use in a specific population and
increase the body of evidence or knowledge concerning the effectives of MNT and the
role of dietetic professionals in achieving positive outcomes.
Aggregate outcome data provide leverage for demonstrating professional value and
accountability, outcomes management, and system/processes improvement. Accrediting
agencies such as the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) and the National Committee for Quality Assurance (NCQA) are now including
performance measurement and outcomes monitoring as a requirement for accreditation.
For example, in order to meet JCAHO standard LD.1.10.3 leaders must evaluate the
outcomes related to use of clinical practice guidelines and make any necessary changes to
©2006 American Dietetic Association
Disorders of Lipid Metabolism Toolkit
improve pertinent processes. The intent of LD.1.10.3 states that the organization must
monitor the guidelines it implements in order to judge their effectiveness.
What Types of Outcomes Should be Measured and Monitored?
The nutrition care process recommends that the outcomes to be measured and monitored
should be directly related to the nutrition diagnosis and the nutrition intervention goals
The following four categories are listed with examples of potential outcomes (but not
limited to those listed) that could be collected related to each category.
 Direct nutrition intervention outcomes such as knowledge gained, behavior
change, food or nutrient changes, improved nutritional status.
 Clinical and health status outcomes such as laboratory values, weight, blood
pressure, risk factor profile changes, signs and symptoms, clinical status,
infections, complications.
 Patient/client-centered outcomes such as quality of life, satisfaction, self-efficacy,
self-management, functional ability.
 Health care utilization and cost outcomes such as medication changes, special
procedures, planned/unplanned clinic visits, preventable hospitalizations, length
of hospitalization, prevent or delay nursing home admission.
How is Data Collected?
Potential outcomes from each evidence-based nutrition practice guideline needs to be
identified, listed in the appropriate category, measured, and then aggregated. To do this,
several collection forms and tools have been developed, including a request and
authorization for release of patient information.
 Request and authorization for release of patient information. Before collecting
patient/client data, a signed confidentiality statement similar to the one included
needs to be signed by each individual.
 Example of a worksheet for collection of individual outcomes. The worksheet is
available for download. Before entering data on the Individual Outcome sheet,
photocopy the sheet one or more times for additional patients/clients.
 Example of group outcomes input sheet and group outcome summary. The
worksheet is set up for 10 patients/clients. Additional rows can be added as
needed.
Directions for Using Excel Worksheets to Monitor Outcomes Data
This workbook has three sheets: Individual Outcomes Monitoring, Aggregate Input Form
and Aggregate Outcomes Monitoring. You will also find three sample monitoring forms
which are based on the case studies in this Toolkit. The tabs on the bottom let you move
around to the different sheets. Click on the tab and it will go from gray to white. If the
gray is not visible, that is the sheet you can input data.
When there is not data entered you will see things like #DIV/0! or ####. This is because
of the formulas. Numbers will replace these once you input your raw data.
©2006 American Dietetic Association
Disorders of Lipid Metabolism Toolkit
Some information that should not be change: Formulas and items are protected so that
you will not delete them by accident. The places you need to input data are not protected
and you can add and change data.
Before you enter data on the Individual Outcome sheet, you need to duplicate the sheet
one or more times for additional clients.
You can duplicate the Individual Outcomes Monitoring Form worksheet either by just
printing off a blank sheet or by adding all your clients to this workbook. To add a copy of
the Individual Outcomes worksheet to the workbook: Go to the sheet, then click on the
toolbar. Go down to Move or copy sheet and click on the then at the bottom of the box
check create a copy and say OK. Next you will need to go down to the tab and click on it
to highlight and then name the sheet.
Adding more clients to the Aggregate Input Form: This worksheet is currently set for 10
clients. For additional clients, you will need to add more rows to this sheet. First you will
need to unprotect this worksheet. To do this by going to the tool bar and click on tools,
the click on protection. Chose unprotect sheet. You can add a row(s) by pointing and
clicking on the number 15 at the far left of the worksheet. This will highlight the whole
row, then go the toolbar and click insert. This will insert a row. You can repeat this and
add as many rows as you wish.
VERY IMPORTANT! Before you leave a worksheet you need to go back and protect
the worksheet again. This is your safe guard for not deleting formulas. To protect the
worksheet, go back to the tool bar and click on tools, the click on protection. Choose
protect sheet. When the box comes up giving you options of protecting contents objects
and scenarios, and all three are checked. Leave the password blank. Then click OK.
You do not need to enter data on the Aggregate Outcomes Form. This pulls data from the
other sheets. Review the information above to improve data collection. Good data
collection strategies are imperative.
1. Lacey K, Pritchard E. Nutrition care process and model: ADA adopts road map to
quality care and outcomes management. J Am Diet Assoc 2003;103:10611072.
Information for the above text was adapted from reference 1.
Data Privacy and Security
 It is important that a confidentiality statement like the following be attached to all
data reports shared at a site.
o CONFIDENTIAL: This document has been prepared for review and
evaluation by the ______________________ Committee and is entitled to
the protection of the peer review, medical review, quality assurance, or
other similar privileges provided for by state and federal law. It is not to
be copied or distributed without the express, written consent of the legal
department.
©2006 American Dietetic Association
Disorders of Lipid Metabolism Toolkit

A written patient consent must be obtained before sharing any data. The following
is an example informed consent form.
o REQUEST & AUTHORIZATION FOR RELEASE OF PATIENT
INFORMATION
I, hereby authorize the release (patient’s name) of all relevant data in my patient records
to the …..
I understand that I will receive a copy of this consent form if requested.
Client (Parent/Guardian) Signature
Date
Witness Signature
Date