Current State Analysis of Malnutrition Screening for Ambulatory Patients With Inflammatory Bowel Disease Reveals Low Screening Rates and Telehealth as a Risk Factor

TL;DR

This study finds that malnutrition screening for IBD patients is low, especially during telehealth visits, which could lead to worse health outcomes.

Contribution

The study identifies telehealth as a risk factor for low malnutrition screening rates in IBD patients.

Findings

Malnutrition screening occurred in only 56% of outpatient encounters for IBD patients.

Telehealth visits were associated with a 57% lower likelihood of malnutrition screening compared to in-person visits.

Only 12% of screening encounters used a validated malnutrition screening tool.

Abstract

Patients with inflammatory bowel disease (IBD) are at increased risk of malnutrition, which is associated with worse outcomes and has prompted recommendations for regular nutrition screening. This study details a current state analysis of outpatient gastroenterology (GI) malnutrition screening practices for patients with IBD and evaluates risk factors for lack of screening.

This retrospective cohort study included adults with IBD on advanced therapies seen at the University of California, Los Angeles, between 2018 and 2024. Patient data were abstracted from outpatient GI encounters via electronic medical records. A root cause analysis for lack of malnutrition screening was created using a Gemba walk and stakeholder interviews. Multivariable logistic regression evaluated risk factors for lack of screening.

Of 283 included patients, the mean age was 44.4, mean body mass index was 25.9, 53.7% were female, 62.9% were White, and 50.0% had Crohn’s disease. Most (70.7%) had their GI encounters via telehealth. Malnutrition screening was performed at 56% of encounters. When patients were screened, a validated screening tool was used in 12% of encounters. Screening identified malnutrition risk in 11% of encounters and prompted ordering of registered dietician referrals 44% and nutrition labs 56% of the time. Malnutrition screening was less likely if the encounter was via telehealth (vs in-person, odds ratio 0.43, confidence interval [0.23–0.80]).

Improved malnutrition screening among GI physicians for IBD patients is needed. Given telehealth visits were strongly associated with lack of screening, strategies to address this care gap are needed since telehealth has become more common.

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