Continuing Education Questionnaire, page 399 Meets learning need codes 4190, 5040, 5100, 7160 A blueprint-based case study analysis of nutrition services provided in a midterm care facility for the elderly CATHERINE PAQUET; DANIELLE St-ARNAUD-McKENZIE; GUYLAINE FERLAND, PhD; LAURETTE DUBE ´ , PhD ABSTRACT Ensuring nutritionally adequate food intake in institutions is a complex and important challenge for dietitians. To tackle this problem, we argue that dietitians need to adopt a systematic, integrative, and patient-centered approach to identify and manage more effectively organizational determinants of the quality of food intake under their control. In this study, we introduce such an approach, the blueprint-based case study, that we applied in the context of a midterm care facility for elderly patients. Data gathered through interviews and field observations were used to develop, from the perspective of key patient encounters, detailed representations of the food, nutrition, and nursing activities necessary to ensure adequate food intake. These service “blueprints” were developed to illustrate all activities that might potentially impact on the nutritional, sensory, functional, and social quality of patients’ meals. They were also used as roadmaps to develop a case study analysis in which critical areas were identified and op- portunities for improvement put forth, while considering ser- vices’ resources and priorities. By providing a precise, objec- tive, yet comprehensive mapping of the service operations and management, the blueprint-based case study approach represents a valuable tool to determine the optimal allocation of resources to insure nutritionally adequate food intake to patients. J Am Diet Assoc. 2003;103:363-368. E nsuring nutritionally adequate food intake to elderly cli- entele in midterm and long-term healthcare facilities is critical to the quality of care (1). Indeed, patients stay in institutions long enough for food intake to have a positive or detrimental impact on nutritional status. In such settings, low dietary intakes have been strongly associated with weight loss and concomitant protein-energy malnutrition (PEM) (2) and ensuing negative clinical outcomes and increased hospital- ization costs (3-6). Fortunately, malnutrition is in many in- stances treatable and its onset preventable. Vigorous nutri- tional interventions (7), improvements in food catering practices (8), modifications in meal environment (9), and so- cial support from nursing staff (10,11) were all reported to improve food intake, weight, and nutritional status in geriatric patients. Thus, a systematic effort to ensure adequate food intake to elderly patients in institutions promises important payoffs in terms of both patients’ well-being and costs. This, however, is not a simple task and, for dietitians, an important challenge. In all contexts, eating behavior is very complex and subject to numerous social, psychological, and physiologic factors (4). In institutions, factors that influence food consumption and, ulti- mately, nutritional status impact the patient’s condition (1) and the care provided. Unlike other types of healthcare inter- ventions, ensuring adequate food intake is contingent on a number of organizational factors lying outside the patient-pro- fessional encounter, such as menu design, production and de- C. Paquet is a PhD candidate in the Faculty of Manage- ment of McGill University, Montreal, Quebec, Canada; D. St-Arnaud-McKenzie is a PhD candidate and G. Ferland is a professor in the Nutrition Department of the Univer- site´ de Montre´al, Montreal, Quebec, Canada; and L. Dube´ is an associate professor in the Faculty of Management of McGill University, Montreal, Quebec, Canada. Address correspondence to: Laurette Dube´, PhD, Fac- ulty of Management McGill University, 1001 Sherbrooke West, Montreal, Que´bec, Canada H3A 1G5. E-mail: dube@management.mcgill.ca Copyright © 2003 by the American Dietetic Association. 0002-8223/03/10303-0007$35.00/0 doi: 10.1053/jada.2003.50047 PERSPECTIVES IN PRACTICE Journal of THE AMERICAN DIETETIC ASSOCIATION / 363