What is the best way to provide dietetic care to patients admitted to hospital who have been identified as having illness related malnutrition: Which of two current service models benefits patients in the long term?

Two current models of care will be employed during the intervention period and they are described below: a) Hospital Model of Care ( HMoC): Patients who receive the HMoC will receive the following services: 1. Full nutrition assessment as per departmental standards 2. Nutrition care plan developed and implemented during the hospital admission. Discretionary referral to the ambulatory care dietitian. 3. All the Dietary Education provided during hospital admission 4. Long term care plan developed and managed by the hospital dietitian. 5. Time allocation is determined by the needs of the patient but is usually in the range of 60-90 minutes per admission. b) Ambulatory Model of Care ( AMoC): Patients who receive the AMoC will receive the following services: 1. Full nutrition assessment as per departmental standards 2. Nutrition care plan developed and implemented during the hospital admission and immediate referral to the ambulatory care dietitian. 3. Minimal Dietary Education provided during hospital admission. 4. Long term care developed and managed by the ambulatory care dietitian. 5. Time allocation is determined by the AMoC dietitian but will be in the range of 3-6 monthly visits and these take approximately 30-60 minutes. Process 1. During the intervention period the hospital dietitians providing the service to these wards will assess all patients referred using a standardised nutritional assessment tool. If the patient is identified as either at risk or malnourished they will be offered a six month check up after the leave hospital. If the patient accepts this service they will also be screened for eligibility into the study. 2. If patients are eligible for inclusion into the study they will be approached by staff member who does not work on these wards and they will discuss the research study and provide and invite then to participate. If they elect to participate their names will be given to the allocation officer. 3. Details on all patients who meet the eligibility criteria will be forwarded to the allocation officer (AO). This AO will randomly allocate these patients to one of the two models of care. Once allocation has been completed the hospital dietitian will be notified as to what model of care their patients will receive for the next six months. 4. If their patients are allocated the HMoC , they follow the inpatient HMoC protocol as outlined in a). 5. If their patients are allocated the AMoC they follow the inpatient AMoC protocol as outlined in b). This model of care requires the ward dietitian to liaise with ambulatory care dietitian during their patients’ admission in hospital. However, once the patient is discharged from hospital all care is managed by the ambulatory care dietitian.