Evaluation of clinical activities of dietitians-nutritionists in 13 countries using the Professional weighted Activities Score (PwAS): A proposed tool for assessing performance in hospital settings based on activity Prioritization

Objectives: In Latin America, clinical dietitian-nutritionists (DNs) play a crucial role in addressing the rising prevalence of chronic disease and malnutrition within hospitals. However, there is a lack of a common tool to evaluate prioritization activities among nutrition professionals. Having a reliable tool could help standardize and enhance the quality clinical nutrition practice in Latin America, as well as enable optimal utilization of the DN skills, ultimately reducing job burnout and improving quality of care. This study aimed to: 1) develop a Professional Weighted Activities Score (PwAS) to assess the professional activities of DNs in hospital settings according to task prioritization; and 2) apply the new scoring system to a previously collected sample of Latin American DNs. Methods: The PwAS tool was developed using the criteria of a panel of experts from all participating countries. A multicentric and cross-sectional study was conducted among 1222 clinical DNs from 13 Latin American countries to identify their professional activities in public and private health care facilities. The survey comprised 30 questions related to clinical nutrition tasks, with responses weighted according to the priority assigned by an expert panel. Results: A PwAS was developed encompassing 19 activities performed by clinical DN, each assigned a prioritization score by a panel of experts in clinical nutrition. The scoring spectrum ranged from 0 to 100, reflecting the variability in DN engagement with their professional activities. The analysis revealed significant differences in the professional activities of DNs across various countries. Guatemala, Paraguay, and Colombia achieved the highest scores, while Costa Rica, Peru, and Uruguay recorded the lowest. Factors positively associated with higher PwAS scores included greater years of experience and multiple specializations. In contrast, working in low-complexity facilities and facing barriers to task performance were negatively correlated with the PwAS. Conclusions: The significant variation observed in clinical nutrition practices across countries underscores the need for studies to identify underlying causes and develop standardization. The PwAS tool could serve as a valuable resource for hospital administrators seeking to optimize staffing and enhance the quality of nutritional care within Latin American health care systems.