2.1 Nutrition Care Process Model (NCPM)

 The Nutrition Care Process Model (NCPM) serves as a framework for healthcare professionals engaged in providing nutrition and dietetics care. The NCP Model offers a systematic, evidence-based approach to assessing, diagnosing, planning, implementing, and evaluating nutrition and dietetics care. 

Structured around four sequential steps, the NCP Model guides nutrition and dietetics professionals through the process of delivering comprehensive nutrition and dietetics care:

1. Nutrition Assessment and Reassessment: This initial step involves gathering pertinent information about the person's nutritional status, dietary habits, health history, social determinants of health (SDOH) and lifestyle factors. Regular reassessment ensures that care plans remain current and responsive to evolving needs. Reassessment is a future assessment that occurs during a follow up interaction with a patient. The reassessment builds on what the assessment raised as initial findings and also identifies new findings that must be addressed as part of continued care.  

2. Nutrition Diagnosis: Building upon the assessment findings, professionals identify alterations in the nutritional status of the client or patient through naming nutrition-related problems and establishing clear, actionable objectives.* Nutrition diagnoses serve as the foundation for developing targeted interventions aimed at resolving the cause (or etiology) and/or contributing factors of the problems and meeting specific nutrition needs and goals.

3. Nutrition Intervention: With diagnoses in hand, professionals collaborate with individuals and/or groups of people to develop and implement evidence-based nutrition interventions. These plans of care may include a) customized approaches for food/nutrient provision such as dietary modifications, oral nutrition supplementation, and enteral or parenteral nutrition, b) nutrition education, c) nutrition counseling (frequently aiming to achieve behavior change among other objectives), and d) support services (such as coordination of nutrition and dietetics care) tailored to promote optimal health outcomes.

4. Nutrition Monitoring and Evaluation: Continuous monitoring and evaluation are integral to assessing the effectiveness of nutrition interventions and adjusting care plans as needed. By tracking progress and outcomes over time, healthcare professionals can ensure that individuals and/or groups of people receive ongoing support and achieve their nutrition-related goals.

Through its structured approach, the NCP Model enhances consistency, quality, and description of nutrition/dietetics care and related health outcomes. While care delivery remains individualized to meet the unique needs of those being served, the NCP Model provides a standardized framework for guiding professionals through the delivery process. The structured framework facilitates data aggregation for patient populations and subsequent data analytics, outcomes management and opportunities to research and improve the NCP Model itself.  

The entryway to the NCP is via nutrition screening or referral of client or patient.  The purpose of the screening and referral system is to identify and refer those who have or are at risk for nutrition problems, who are appropriate to receive nutrition care services as delivered by the NCP. The nutrition screening process utilizes valid, and reliable screening tools to identify and document nutrition risk. The screening and referral system improve interdisciplinary collaboration among healthcare professionals. 

The output of the NCPM is emphasizing the importance of studying the the NCP itself, aggregating data to conduct research, and quality improvement initiatives, and calculating/reporting quality indicators like eCQMs (electronic Continuous Quality Measures that are currently utilized as far as we know in the United States). 

External and professional factors are depicted in the two outer rings to reflect practice settings, health care systems, social systems, and economic environment. The middle ring includes variables that influence quality of practice and include: dietetics knowledge, skills and competencies, critical thinking, collaboration, communication and documentation, evidence-based practice, and code of ethics. The center circle (core) features the person/population that interacts with the nutrition and dietetics professional and as such the core of the NCPM symbolizes people-centered nutrition care delivery. 

Reprinted from J Acad Nutr Diet. 2017 Dec, Swan WI, Vivanti A, Hakel-Smith NA, Hotson B, Orrevall Y, Trostler N, Beck Howarter K, Papoutsakis C., Nutrition Care Process and Model Update: Toward Realizing People-Centered Care and Outcomes Management, Pages 2003-14, Copyright 2017, with permission from Elsevier. https://www.jandonline.org/

*This is an updated definition because V2 standards site alteration in nutrition status and point to LOINC 75305-3 Nutritional status with synonym nutrition diagnosis.