Developing the Quality in Nutrition Care Model for Dietitians (QUINCE‐MOD) in primary care: A mixed‐method survey of healthcare consumers and professionals

**Background:** Evidence-based models are effective tools for quality improvement in healthcare. The Quality in Nutrition Care (QUINCE) model describes quality nutrition care in primary care but had not been applied to dietetics. Complexity science suggests that reductionist approaches to quality improvement are inadequate for complex systems like primary care. This study aimed to evaluate consumer and professional perspectives on 10 statements about quality dietetic care and to enhance the QUINCE model for dietetics practice.

**Methods:** The study used a two-phased, mixed-methods approach within a pragmatic paradigm. Phase 1 evaluated consumer and professional perspectives on 10 statements derived from 'Crossing the Quality Chasm'. Phase 2 tested and enhanced the QUINCE model using qualitative responses. Participants were recruited via social media, research databases, and professional networks. Quantitative data were analyzed using descriptive statistics (≥75% agreement threshold) and Mann-Whitney U tests. Qualitative content analysis used a deductive-inductive approach with a categorization matrix based on QUINCE model components.

**Key Results:** The survey was completed by 114 consumers and 107 professionals. Most consumers (65.8%) had received dietitian care. Professionals were mostly dietitians (78.5%). At least 75% of consumers agreed/strongly agreed with all 10 statements. Professionals reached the 75% threshold on only 7 statements. The three statements below threshold were: Statement 4 (unrestricted access to own information; 57.9% professional agreement), Statement 5 (evidence-based care without variation; 67.3%), and Statement 7 (access to dietitian performance/safety information; 57.0%). Statistically significant differences in rating distributions were found for Statement 2 (professional mean rank 120.50 vs consumer 102.09; p=0.010), Statement 8 (professional 118.75 vs consumer 103.73; p=0.025), Statement 4 (professional 91.07 vs consumer 129.70; p<0.001), and Statement 7 (professional 90.96 vs consumer 129.81; p<0.001). Qualitative analysis of 805 data points (443 consumer, 362 professional) identified 57 level 3 categories. The QUINCE model was modified to produce QUINCE-MOD, adding a sixth component 'Practice support structures' with subcomponents 'Informed and monitored' and 'Technology'. Component 3 was modified to include safe care. Two subcomponents were merged into 'Collaboration'.

**Clinical Implications:** The QUINCE-MOD provides a framework for primary care dietetics services to evaluate and improve quality across six components: integration into societal/healthcare systems; availability/accessibility/affordability; safe/current/evidence-based care; positive relationships; personalised care; and practice support structures. The model reflects both consumer wants and professional capabilities. Key tensions identified include balancing transparency with safety in information sharing, managing variation in care delivery, and developing systems for performance monitoring. The model may be used to identify quality improvement opportunities, such as formalizing care pathways with referring practitioners. Further research is needed on transferability to under-represented populations and generalisability to the wider Australian population.