Paper Type

Master's Thesis


Brooks College of Health

Degree Name

Master of Science in Health Science: Nutrition (MSH)


Nutrition & Dietetics

NACO controlled Corporate Body

University of North Florida. Department of Nutrition & Dietetics

First Advisor

Dr. Lauri Wright

Second Advisor

Dr. Catherine Christie

Third Advisor

Dr. Zhiping Yu

Department Chair

Dr. Judith Rodriguez

College Dean

Dr. Curt Lox


In 2012 the Academy of Nutrition and Dietetics (Academy) and the American Society for Enteral and Parenteral Nutrition (ASPEN) published a consensus statement outlining the clinical characteristics recommended for the diagnosis of adult malnutrition, specifically undernutrition. The Academy and ASPEN recognized the need to standardize the approach to identify, diagnose and document malnutrition. There continues to be growing awareness that malnutrition plays a significant role on health outcomes and on the course of treatment for patients. The high prevalence of malnutrition at hospital admission identifies the need for more awareness, recognition and treatment at an earlier stage, such as primary care or an outpatient setting. The primary objective of this study was to assess the effectiveness of a malnutrition education program implemented in the outpatient clinics at James A. Haley Veterans’ Hospital and Clinics in Tampa, FL. The education program involved hands-on Nutrition Focused Physical Exam Workshop training for outpatient dietitians, education to outpatient dietitians regarding policies and procedures for improved identification and documentation of malnutrition, and education to primary care physicians at a formal staff meeting and team meetings and huddles. The Ambulatory Care Nutrition Section Chief recognized the need for further nutrition focused physical exam (NFPE) training for outpatient dietitians and general malnutrition training to outpatient providers. The interventions implemented as part of the malnutrition education program in the outpatient setting at James A. Haley Veterans’ Hospital and Clinics showed statistically significant, desired outcomes as indicated by improvements in outpatient dietitian confidence levels with performing NFPE and statistically significant associations between fiscal year and presence of malnutrition codes to evaluate effectiveness of training for both dietitians and primary care physicians.