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Diep-Pham HT, Donald N, Wall CL. Malnutrition screening tool use in a New Zealand hospital: Reliability and rates of malnutrition screening on admission. Nutr Diet 2023; 80:530-537. [PMID: 37614059 DOI: 10.1111/1747-0080.12838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/07/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023]
Abstract
AIMS This research aimed to assess the rate and reliability of routine nurse-completed malnutrition screening and report the prevalence of malnutrition risk on admission to Christchurch Hospital. METHODS Student dietitians administered the Malnutrition Screening Tool to patients in three speciality wards within 48 h of admission. Student dietitians' Malnutrition Screening Tool scores were compared against documented nurse-completed Malnutrition Screening Tool scores. Data were analysed using descriptive statistics, Fisher's exact test, and Cohen's kappa tests (interrater reliability ⱪ). A p-value <0.05 was considered statistically significant. RESULTS Student dietitians, using the Malnutrition Screening Tool, screened 360 (96%) of 377 eligible patients while nurses screened 332 (88%) patients. Student dietitians and nurses screened 119 patients (33%) and 63 patients (18%) respectively at risk of malnutrition. There was fair agreement (ⱪ = 0.311) in Malnutrition Screening Tool total scores between nurses and student dietitians. There was a significant difference in the proportion of patients screened at risk of malnutrition between nurses and student dietitians (p < 0.0001). CONCLUSION Malnutrition risk remains high in acute care settings. Nurses were less likely to screen patients as at risk of malnutrition than student dietitians. Regular support and training in using Malnutrition Screening Tool may help improve the rate and reliability of routine malnutrition screening.
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Affiliation(s)
| | - Natasha Donald
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Catherine L Wall
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Taipa-Mendes AM, Amaral TF, Gregório M. Undernutrition risk and nutritional screening implementation in hospitals: Barriers and time trends (2019-2020). Clin Nutr ESPEN 2021; 45:192-199. [PMID: 34620317 DOI: 10.1016/j.clnesp.2021.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Undernutrition screening is the starting point for high-quality nutrition care. In Portugal, the systematic nutritional risk assessment became mandatory for every inpatient in hospitals of the National Health System in 2019. The aims of this study were to describe the country's nutritional risk prevalence of hospitalized patients, and the experience of implementing a systematic undernutrition screening method, including time trends, barriers, and facilitators. METHODS This research was carried out in Portuguese Public Hospitals (n = 49) and included both the analysis of data from health information systems between January 2019 and December 2020 and from an online survey. The performance indicators are described for 38 hospitals that use the SClinico electronic health records software provided by the Ministry of Health. The Nutritional Risk Screening 2002 (NRS 2002) was applied to adult patients and the STRONGkids to paediatric patients. In order to assess barriers and facilitators the online survey was applied to all public hospitals (n = 49), including Hospital Centres and Local Health Units. RESULTS In 2020, 25.5% of the screened patients were nutritionally at risk. There was a significant increase in the proportion of patients screened from the pre- (10.6 ± 1.9%) to the post-adaptation period of the electronic health record (23.3 ± 4.8%, July-December 2019, and 25.4 ± 2.2%, January-June 2020) (p < 0.001). Data from 41 Hospital Centres and Local Health Units (84%) were obtained from the online survey. The major barriers identified were the lack of human resources (89.7%) and equipment (41.0%), as well as insufficient knowledge about the role of undernutrition screening (35.9%). The most-reported facilitators were the integration of undernutrition screening to electronic health records (22.2%) and good multidisciplinary articulation (36.1%). CONCLUSION The high prevalence of nutritional risk justifies the mandatory nutritional screening, which leads to the improvement of the quality of hospital care. However, local and national efforts are warranted to adapt nutritional screening policies to local conditions and to increase and improve its implementation.
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Affiliation(s)
- A M Taipa-Mendes
- Faculty of Nutrition and Food Sciences, University of Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal.
| | - T F Amaral
- Faculty of Nutrition and Food Sciences, University of Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal
| | - M Gregório
- Faculty of Nutrition and Food Sciences, University of Porto, Rua do Campo Alegre, 823, 4150-180, Porto, Portugal; Directorate-General of Health, Alameda Afonso Henriques, 45 1049-005, Lisboa, Portugal
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Raphaeli O, Singer P. Towards personalized nutritional treatment for malnutrition using machine learning-based screening tools. Clin Nutr 2021; 40:5249-5251. [PMID: 34534893 DOI: 10.1016/j.clnu.2021.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 01/04/2023]
Abstract
Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional therapy. Yet, despite the presence of many nutrition screening tools for use in the hospital setting, there is no consensus regarding the best tool as well as inadequate adherence to screening practices which impairs the achievement of effective nutritional therapy. In recent years, artificial intelligence and machine learning methods have been widely used, across multiple medical domains, to aid clinical decision making and to improve quality and efficiency of care. Therefore, Yin and colleagues propose a machine learning based individualized decision support system aimed to identify and grade malnutrition in cancer patients by applying unsupervised and supervised machine learning methods on nationwide cohort. This approach, demonstrate the ability of machine learning methods to create tools to recognize malnutrition. The machine learning based screening serves as a first layer in a nutritional therapy workflow and provides improved support for decision making of health professionals to fit individualized nutritional therapy in at-risk patients.
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Affiliation(s)
- Orit Raphaeli
- Industrial Engineering and Management, Ariel University, Israel; General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital. Affiliated to Sackler School of Medicine, Tel Aviv University, Israel.
| | - Pierre Singer
- General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital. Affiliated to Sackler School of Medicine, Tel Aviv University, Israel
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Recio-Saucedo A, Smith GB, Redfern O, Maruotti A, Griffiths P. Observational study of the relationship between nurse staffing levels and compliance with mandatory nutritional assessments in hospital. J Hum Nutr Diet 2021; 34:679-686. [PMID: 33406321 DOI: 10.1111/jhn.12847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/24/2020] [Accepted: 10/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the UK, it is recommended that hospital patients have their nutritional status assessed within 24 h of admission using the Malnutrition Universal Screening Tool (MUST). The present study aimed to examine the association between nurse staffing levels and missed nutritional status assessments. METHODS A single-centre, retrospective, observational study was employed using routinely collected MUST assessments from 32 general adult hospital wards over 2 years, matched to ward nurse staffing levels. We used mixed-effects logistic regression to control for ward characteristics and patient factors. RESULTS Of 43 451 instances where staffing levels could be linked to a patient for whom an assessment was due, 21.4% had no MUST score recorded within 24 h of admission. Missed assessments varied between wards (8-100%). There was no overall association between registered nurse staffing levels and missed assessments; although higher admissions per registered nurse were associated with more missed assessments [odds ratio (OR) = 1.09, P = 0.005]. Higher healthcare assistant staffing was associated with lower rates of missed assessments (OR = 0.80, P < 0.001). There was a significant interaction between registered nurses and healthcare assistants staffing levels (OR = 0.97, P = 0.011). CONCLUSIONS Despite a written hospital policy requiring a nutritional assessment within 24 h of admission, missed assessments were common. The observed results show that compliance with the policy for routine MUST assessments within 24 h of hospital admission is sensitive to staffing levels and workload. This has implications for planning nurse staffing.
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Affiliation(s)
- A Recio-Saucedo
- NIHR Collaboration for Leadership in Applied Heath Research and Care (Wessex, University of Southampton, Southampton, UK
| | - G B Smith
- Faculty of Health and Social Sciences, University of Bournemouth, Bournemouth, UK
| | - O Redfern
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - A Maruotti
- Dipartimento di Scienze Economiche, Libera Universita Maria Santissima Assunta, Roma, Italy
| | - P Griffiths
- NIHR Collaboration for Leadership in Applied Heath Research and Care (Wessex, University of Southampton, Southampton, UK
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Delattre T, Michel C, Noël D, Vanesse V, Lacrosse D. Lorsque le dépistage nutritionnel est confié au patient : une étude prospective observationnelle au sein d’un hôpital universitaire belge. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Keller HH, Laur C, Dhaliwal R, Allard JP, Clermont-Dejean N, Duerksen DR, Elias E, Gramlich L, Lakananurak N, Laporte M. Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals. JPEN J Parenter Enteral Nutr 2020; 45:670-684. [PMID: 33236411 DOI: 10.1002/jpen.2047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 01/04/2023]
Abstract
Hospital malnutrition is a longstanding problem that continues to be underrecognized and undertreated. The aim of this narrative review is to summarize novel, solution-focused, recent research or commentary to update providers on the prevention of iatrogenic malnutrition as well as the detection and treatment of hospital malnutrition. A narrative review was completed using the top 11 clinically relevant nutrition journals. Of the 13,850 articles and editorials published in these journals between 2013 and 2019, 511 were related to hospital malnutrition. A duplicate review was used to select (n = 108) and extract key findings from articles and editorials. Key criteria for selection were population of interest (adult hospital patients, no specific diagnostic group), solution-focused, and novel perspectives. Articles were categorized (6 classified in >1 category) as Screening and Assessment (n = 17), Standard (n = 25), Advanced (n = 12) and Specialized Nutrition Care (n = 8), Transitions (n = 15), Multicomponent (n = 21), Education and Empowerment (n = 9), Economic Impact (n = 3), and Guidelines (n = 4) for summarizing. Research advances in screening implementation, standard nutrition care, transitions, and multicomponent interventions provide new strategies to consider for malnutrition prevention (iatrogenic), detection, and care. However, several areas requiring further research were identified. Specifically, larger and more rigorous studies that examine health outcomes and economic analyses are urgently needed.
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Affiliation(s)
- Heather H Keller
- Schlegel-University of Waterloo Research institute for Aging, Waterloo, Ontario, Canada
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Rupinder Dhaliwal
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, Ontario, Canada
| | - Johane P Allard
- Department of Medicine, University of Toronto, Toronto General Hospital, University Health Network Toronto, Toronto, Ontario, Canada
| | - Nayima Clermont-Dejean
- Clinical Nutrition, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald R Duerksen
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Evan Elias
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Narisorn Lakananurak
- Department of Medicine, University of Alberta, Edmonton, Canada.,Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Manon Laporte
- Department of Clinical Nutrition, Réseau de santé Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada
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Keller H, Koechl JM, Laur C, Chen H, Curtis L, Dubin JA, Gramlich L, Ray S, Valaitis R, Yang Y, Bell J. More-2-Eat implementation demonstrates that screening, assessment and treatment of malnourished patients can be spread and sustained in acute care; a multi-site, pretest post-test time series study. Clin Nutr 2020; 40:2100-2108. [PMID: 33077271 DOI: 10.1016/j.clnu.2020.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Malnutrition in medical and surgical inpatients is an on-going problem. More-2-Eat (M2E) Phase 1 demonstrated that improved detection and treatment of hospital malnutrition could be embedded into routine practice using an intensive researcher-facilitated implementation process. Yet, spreading and sustaining new practices in diverse hospital cultures with minimal researcher support is unknown. AIMS To demonstrate that a scalable model of implementation can increase three key nutrition practices (admission screening; Subjective Global Assessment (SGA); and medication pass (MedPass) of oral nutritional supplement) in diverse acute care hospitals to detect and treat malnutrition in medical and surgical patients. METHODS Ten hospitals participated in this pretest post-test time series implementation study from across Canada, including 21 medical or surgical units (Phase 1 original units (n = 4), Phase 1 hospital new units (n = 9), Phase 2 new hospitals and units (n = 8)). The scalable implementation model included: training champions on implementation strategies and providing them with education resources for teams; creating a self-directed audit and feedback process; and providing mentorship. Standardized audits of all patients on the study unit on an audit day were completed bi-monthly to track nutrition care activities since admission. Bivariate comparisons were performed by time period (initial, mid-term and final audits). Run-charts depicted the trajectory of change and qualitatively compared to Phase 1. RESULTS 5158 patient charts were audited over the course of 18-months. Admission nutrition screening rates increased from 50% to 84% (p < 0.0001). New Phase 1 units more readily implemented screening than Phase 2 sites, and the original Phase 1 units generally sustained screening practices from Phase 1. SGA was a sustained practice at Phase 1 hospitals including in new Phase 1 units. The new Phase 2 units improved completion of SGA but did not reach the levels of Phase 1 units (original or new). MedPass almost doubled over the time periods (7%-13% of all patients p < 0.007). Other care practices significantly increased (e.g. volunteer mealtime assistance). CONCLUSION Nutrition-care activities significantly increased in diverse hospital units with this scalable model. This heralds the transition from implementation research to sustained changes in routine practice. Screening, SGA, and MedPass can all be implemented, improve nutrition care for all patients, spread within an organization, and for the most part, sustained (and in the case of original Phase 1 units, for over 3 years) with champion leadership.
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Affiliation(s)
- Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON N2J 0E2, Canada; Department of Kinesiology, University of Waterloo, Canada.
| | | | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; NNEPro Global Centre for Nutrition and Health in Cambridge, Cambridge, UK
| | - Helen Chen
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Lori Curtis
- Department of Economics, University of Waterloo, Canada
| | - Joel A Dubin
- School of Public Health and Health Systems and Department of Statistics and Actuarial Science, University of Waterloo, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Canada
| | - Sumantra Ray
- School of Humanities and Social Sciences, University of Cambridge, Cambridge, UK; NNEPro Global Centre for Nutrition and Health in Cambridge, Cambridge, UK; School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Renata Valaitis
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Yang Yang
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Jack Bell
- School of Human Movement and Nutrition Sciences, The University of Queensland, Australia; The Prince Charles Hospital, Australia
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Chourdakis M, Grammatikopoulou MG, Poulia KA, Passakiotou M, Pafili ZK, Bouras E, Doundoulakis I, Galitsianos I, Lappa T, Karakatsanis A, Heyland DK. Translation of the modified NUTRIC score and adaptation to the Greek ICU setting. Clin Nutr ESPEN 2019; 29:72-76. [DOI: 10.1016/j.clnesp.2018.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023]
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Suárez-Llanos JP, Mora-Mendoza A, Benítez-Brito N, Pérez-Méndez L, Pereyra-García-Castro F, Oliva-García JG, Palacio-Abizanda JE. Validity of the new nutrition screening tool Control of Food Intake, Protein, and Anthropometry (CIPA) in non-surgical inpatients. Arch Med Sci 2018; 14:1020-1024. [PMID: 30154883 PMCID: PMC6111349 DOI: 10.5114/aoms.2017.66084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/18/2016] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION There is no gold-standard method for hospital nutrition screening. The new screening tool termed Control of Food Intake, Protein, and Anthropometry (CIPA) gives positive results when at least one of the following parameters is met: control of food intake for 72 h < 50%, serum albumin < 3 g/dl, body mass index < 18.5 kg/m2 or mid-upper arm circumference ≤ 22.5 cm. This method was validated in comparison with Subjective Global Assessment (SGA) in hospitalized patients with non-surgical pathologies. MATERIAL AND METHODS A prospective, longitudinal study was performed on 221 consecutively enrolled patients. Prevalence or risk of malnutrition was estimated with CIPA vs. SGA screening at hospital admission and the concordance (k index - K) between the two methods and their sensitivity (S) and specificity (SP) were studied. Mean length of stay (LOS), mortality, and rate of early readmission were analyzed. RESULTS The prevalence or risk of malnutrition identified by CIPA and SGA was 35.7% and 23.1%, respectively. K was 0.401 (p < 0.001); S and SP of CIPA vs. SGA were 72.5% and 75.3%, respectively. In contrast to SGA, CIPA-positive patients had an increased mean LOS compared to the negative ones (19.53 vs. 12.63 days, p < 0.001). Both methods detected a major risk of mortality in positive patients, but no difference in early readmission. CONCLUSIONS The CIPA and the SGA screening tools detect patients with a higher risk of mortality, but only CIPA identifies patients with an increased mean LOS. CIPA screening proved valid for use in non-surgical inpatients.
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Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Alejandra Mora-Mendoza
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Néstor Benítez-Brito
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Lina Pérez-Méndez
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria and Primary Healthcare, CIBER CIBER, Respiratory Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | | | - José Gregorio Oliva-García
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - José Enrique Palacio-Abizanda
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Suárez-Llanos JP, Benítez-Brito N, Vallejo-Torres L, Delgado-Brito I, Rosat-Rodrigo A, Hernández-Carballo C, Ramallo-Fariña Y, Pereyra-García-Castro F, Carlos-Romero J, Felipe-Pérez N, García-Niebla J, Calderón-Ledezma EM, González-Melián TDJ, Llorente-Gómez de Segura I, Barrera-Gómez MÁ. Clinical and cost-effectiveness analysis of early detection of patients at nutrition risk during their hospital stay through the new screening method CIPA: a study protocol. BMC Health Serv Res 2017; 17:292. [PMID: 28424063 PMCID: PMC5397674 DOI: 10.1186/s12913-017-2218-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 04/01/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Malnutrition is highly prevalent in hospitalized patients and results in a worsened clinical course as well as an increased length of stay, mortality, and costs. Therefore, simple nutrition screening systems, such as CIPA (control of food intake, protein, anthropometry), may be implemented to facilitate the patient's recovery process. The aim of this study is to evaluate the effectiveness and cost-effectiveness of implementing such screening tool in a tertiary hospital, consistent with the lack of similar, published studies on any hospital nutrition screening system. METHODS The present study is carried out as an open, controlled, randomized study on patients that were admitted to the Internal Medicine and the General and Digestive Surgery ward; the patients were randomized to either a control or an intervention group (n = 824, thereof 412 patients in each of the two study arms). The control group underwent usual inpatient clinical care, while the intervention group was evaluated with the CIPA screening tool for early detection of malnutrition and treated accordingly. CIPA nutrition screening was performed upon hospital admission and classified positive when at least one of the following parameters was met: 72 h food intake control < 50%, serum albumin < 3 g/dL, body mass index < 18.5 kg/m2 (or mid-upper arm circumference ≤ 22.5 cm). In this case, the doctor decided on whether or not providing nutrition support. The following variables will be evaluated: hospital length of stay (primary endpoint), mortality, 3-month readmission, and in-hospital complications. Likewise, the quality of life questionnaires EQ-5D-5 L are being collected for all patients at hospital admission, discharge, and 3 months post-discharge. Analysis of cost-effectiveness will be performed by measuring effectiveness in terms of quality-adjusted life years (QALYs). The cost per patient will be established by identifying health care resource utilization; cost-effectiveness will be determined through the incremental cost-effectiveness ratio (ICER). We will calculate the incremental cost per QALY gained with respect to the intervention. DISCUSSION This ongoing trial aims to evaluate the cost-effectiveness of implementing the malnutrition screening tool CIPA in a tertiary hospital. TRIAL REGISTRATION Clinical Trial.gov ( NCT02721706 ). First receivevd: March 1, 2016 Last updated: April 8, 2017 Last verified: April 2017.
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Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Néstor Benítez-Brito
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Laura Vallejo-Torres
- Canary Foundation for Health Research (FUNCANIS) Evaluation Service of the Canary Health System (SESCS), Research Network on Health Services Chronic Disease (REDISSEC), Canary Center for Biomedical Research (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Irina Delgado-Brito
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Adriá Rosat-Rodrigo
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Carolina Hernández-Carballo
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Foundation for Health Research (FUNCANIS) Evaluation Service of the Canary Health System (SESCS), Research Network on Health Services Chronic Disease (REDISSEC), Canary Center for Biomedical Research (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Francisca Pereyra-García-Castro
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Juan Carlos-Romero
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nieves Felipe-Pérez
- Internal Medicine Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jennifer García-Niebla
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Ignacio Llorente-Gómez de Segura
- Endocrinology and Nutrition Department, Hospital Universitario Nuestra Señora de Candelaria, Ctra. Del Rosario 145, Santa Cruz de Tenerife, 38010 Spain
| | - Manuel Ángel Barrera-Gómez
- General and digestive surgery Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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Marques-Vidal P, Khalatbari-Soltani S, Sahli S, Coti Bertrand P, Pralong F, Waeber G. Undernutrition is associated with increased financial losses in hospitals. Clin Nutr 2017; 37:681-686. [PMID: 28258776 DOI: 10.1016/j.clnu.2017.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/27/2017] [Accepted: 02/12/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS Undernutrition is associated with increased hospital costs. Whether these increased costs are totally compensated by third payer systems has not been assessed. We aimed to assess the differences between actual and reimbursed hospital costs according to presence/absence of nutritional risk, defined by a Nutritional risk screening-2002 (NRS-2002) score ≥3. METHODS Retrospective study. Administrative data for years 2013 and 2014 of the department of internal medicine of the Lausanne university hospital. The data included total and specific costs (i.e. clinical biology, treatments, pathology). Reimbursed costs were based on the Swiss Diagnosis Related Group (DRG) system. RESULTS 2200 admissions with NRS-2002 data were included (mean age 76 years, 53.9% women), 1398 (63.6%) of which were considered nutritionally 'at-risk'. After multivariate adjustment, patients nutritionally 'at-risk' had higher costs (multivariate-adjusted difference ± standard error: 34,206 ± 1246 vs. 22,214 ± 1666 CHF, p < 0.001) and higher reimbursements (26,376 ± 1105 vs. 17,783 ± 1477 CHF, p < 0.001). Still, the latter failed to cover the costs, leading to a deficit between costs and reimbursements of 7831 ± 660 CHF in patients 'at-risk' vs. 4431 ± 881 in patients 'not at-risk' (p < 0.003). Being nutritionally 'at-risk' also led to a lower likelihood of complete coverage of costs: multivariate-adjusted odds ratio and 95% confidence interval 0.77 (0.62-0.97). Patients 'at-risk' had lower percentage of total costs in medical interventions, food, imaging and "other", but the absolute differences were less than 2%. CONCLUSION Hospital costs of patients nutritionally 'at-risk' are less well reimbursed than of patients 'not at-risk'. Better reporting of undernutrition in medical records and better reimbursement of undernourished patients is needed.
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Affiliation(s)
- Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Saman Khalatbari-Soltani
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland; Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
| | - Sahbi Sahli
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Pauline Coti Bertrand
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
| | - François Pralong
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
| | - Gérard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
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12
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Cooper PL, Raja R, Golder J, Stewart AJ, Shaikh RF, Apostolides M, Savva J, Sequeira JL, Silvers MA. Implementation of nutrition risk screening using the Malnutrition Universal Screening Tool across a large metropolitan health service. J Hum Nutr Diet 2016; 29:697-703. [DOI: 10.1111/jhn.12370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- P. L. Cooper
- Kingston Centre; Monash Health; Melbourne VIC Australia
| | - R. Raja
- Monash Medical Centre; Monash Health; Melbourne VIC Australia
| | - J. Golder
- Dandenong Hospital; Monash Health; Melbourne VIC Australia
| | - A. J. Stewart
- Kingston Centre; Monash Health; Melbourne VIC Australia
| | - R. F. Shaikh
- Dandenong Hospital; Monash Health; Melbourne VIC Australia
| | | | - J. Savva
- Moorabbin Hospital; Monash Health; Melbourne VIC Australia
| | - J. L. Sequeira
- Dandenong Hospital; Monash Health; Melbourne VIC Australia
| | - M. A. Silvers
- Moorabbin Hospital; Monash Health; Melbourne VIC Australia
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