A Dietitian-Driven Unified Nutritional Care Model (ADDUCE)

Disease‐related malnutrition is common among hospitalised medical patients and isassociated with prolonged hospital stay, poorer clinical outcomes, reduced quality oflife, and increased healthcare costs. Although evidence‐based guidelines recommendsystematic nutritional risk screening and nutritional treatment, implementation inroutine clinical practice remains inconsistent. In many healthcare systems, includingDenmark, responsibility for nutritional risk screening and nutritional care planning isprimarily assigned to nursing staff, while clinical dietitians are typically involvedonly following referral.The ADDUCE trial (A Dietitian‐Driven Unified Nutritional Care Model) evaluates analternative organisational model for delivering hospital nutritional care. Theintervention is based on systematic integration of clinical dietitians into ward teams,with dietitians assuming primary responsibility for nutritional risk screening,nutritional assessment, nutritional care planning, and individualised nutritionaltreatment in close collaboration with nursing staff. Dietitians are present on the wardsdaily, participate in routine ward activities, and proactively identify patientsrequiring nutritional care rather than relying solely on referrals.The study uses a stepped‐wedge cluster‐randomised controlled design conducted acrossthree medical wards at Gødstrup Hospital, Denmark. All participating wards begin in thecontrol condition, representing current clinical practice. The intervention is thenintroduced sequentially across wards in a randomised order until all wards haveimplemented the dietitian‐driven model. This design allows each ward to contribute dataunder both control and intervention conditions while facilitating implementation at wardlevel.Approximately 216 participants will be prospectively recruited and enrolled for detaileddata collection, including nutritional intake, body weight, nutritional status, qualityof life, patient satisfaction, and other clinical and patient‐reported outcomes. Inaddition, routinely collected hospital data from all eligible patients admitted toparticipating wards during the study period will be used to evaluate length of hospitalstay and hospital readmissions. The enrolled cohort will provide detailed clinicalinformation that supports adjusted analyses of secondary outcomes.The purpose of the study is to determine whether a dietitian‐driven model of nutritionalcare can improve patient outcomes and healthcare efficiency compared with currentpractice. The study also aims to evaluate whether earlier identification and treatment ofpatients at nutritional risk can contribute to more systematic nutritional care inhospital settings.