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Crouse J, Feuling MB, Winter T, Goday PS, Smith A. Electronic health record time-tracking provides real-time data to measure and benchmark dietitian productivity. J Hum Nutr Diet 2024; 37:105-110. [PMID: 37721196 DOI: 10.1111/jhn.13236] [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: 03/21/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Traditional methods for benchmarking dietitian productivity are time-consuming and fail to accurately measure the total time spent providing nutrition care. An electronic health record (EHR)-based tool that allows for daily tracking of both face-to-face and patient care coordination time for dietitians was created. We assessed whether it provided consistent, continuous measurement of time and productivity. METHODS This tool was created in an independent paediatric academic healthcare system in the USA. Time spent by dietitians in face-to-face settings and care coordination were tracked. Changes in time spent between the years 2013-2016 versus 2018-2019 were also analysed. RESULTS The outpatient dietitian spent a mean total of 66.4 min per patient (37.8 ± 6.0 min in face-to-face care and 28.6 ± 5.2 min in care coordination). The total times and fractions spent on face-to-face and care coordination time varied by specialty. Comparison of the two periods of time revealed 75% more productivity on average of dietitians in different outpatient settings after including care coordination tracking. In addition, dietitians were more likely to document time spent in 5-min increments after the institution of this methodology as opposed to 15-min increments. CONCLUSIONS An EHR-based tool that facilitates the documentation of both face-to-face time and patient care coordination time is feasible and enables consistent, continuous measurement of time and productivity. The real-time data from this tool can be used to support adequate dietitian staffing and be used to create a multicentre database to measure the actual time dietitians need to provide care and generate consistent staffing benchmarks.
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Affiliation(s)
- Jennifer Crouse
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary Beth Feuling
- Technology & Research, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Taylor Winter
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Praveen S Goday
- Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amber Smith
- Nutrition Services, University of California San Francisco Health, San Francisco, California, USA
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2
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Le B, Flier S, Madill J, Joyes C, Dawson E, Wellington C, Adekunte S, Cheng D, John-Baptiste A. Malnutrition risk, outcomes, and costs among older adults undergoing elective surgical procedures: A retrospective cohort study. Nutr Clin Pract 2023; 38:1045-1062. [PMID: 37598397 DOI: 10.1002/ncp.11043] [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: 06/29/2022] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND We examine here the association between malnutrition risk and adverse health outcomes among older adult patients undergoing elective surgical procedures. METHODS We conducted a retrospective study using linked clinical and administrative databases. Malnutrition risk was assessed prior to surgery, defined by unintentional weight loss and decreased food intake. We performed a logistic regression analysis of the primary outcome, a composite adverse outcome measure, including death, bleeding, pneumonia, and other surgical complications. We conducted Fine-Gray proportional hazard regression analysis of hospital length of stay (LOS). We performed a generalized linear regression analysis of in-hospital cost data. All regression analyses controlled for frailty, age, sex, surgical category, and comorbidities. RESULTS Of a total of 3457 older adult elective surgical patients (65-102 years), 310 (9.0%) screened positive for malnutrition risk. In multivariable regression analyses, malnutrition risk was associated with an increased risk of the composite adverse outcome (odds ratio [OR] = 1.74; 95% CI = 1.25-2.39), higher hospitalization costs (relative cost = 1.84; 95% CI = 1.59-2.13), and a decreased risk of discharge from the hospital (hazard ratio = 0.67; 95% CI = 0.59-0.77) compared with those who screened negative. CONCLUSION Older adult patients with malnutrition risk were at an increased risk of adverse surgical outcomes, had longer LOS in the hospital, and incurred higher costs of care. It is important to screen for malnutrition risk and refer older adults for dietetic consults prior to elective surgery.
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Affiliation(s)
- Bill Le
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Suzanne Flier
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Sciences Research Institute, London, Ontario, Canada
| | - Janet Madill
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Catherine Joyes
- SouthWestern Academic Health Network, London, Ontario, Canada
| | - Emily Dawson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Chris Wellington
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Shadia Adekunte
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Davy Cheng
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
- Centre for Medical Evidence, Decision Integrity and Clinical Impact, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ava John-Baptiste
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Sciences Research Institute, London, Ontario, Canada
- Centre for Medical Evidence, Decision Integrity and Clinical Impact, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada
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3
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Arensberg MB, Brunton C, Richardson B, Bolhack S. The Case for Malnutrition Quality Measures and Nutrition-Focused Quality Improvement Programs (QIPs) in US Skilled Nursing Facilities. Healthcare (Basel) 2022; 10:healthcare10030549. [PMID: 35327026 PMCID: PMC8949306 DOI: 10.3390/healthcare10030549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 01/22/2023] Open
Abstract
As skilled nursing in the United States moves to a value-based model, malnutrition care remains a critical gap area that is associated with multiple poor health outcomes, including hospital readmissions and declines in functional status, psychosocial well-being, and quality of life. Malnutrition is often undiagnosed/untreated, even though it impacts up to half of skilled nursing facility (SNF) residents, and COVID-19 infections/related symptoms have likely further increased this risk. In acute care, malnutrition quality measures have been both developed/tested, and nutrition-focused quality improvement programs (QIPs) have been shown to reduce costs and effectively improve care processes and patient outcomes. Less is known about such quality initiatives in SNF care. This perspective paper reviewed malnutrition-related quality measures and nutrition-focused QIPs in SNFs and nursing home care. It identified that although the Centers for Medicare & Medicaid Services (CMS) has had a nursing home Quality Assurance and Performance Improvement (QAPI) program for 10 years and has had SNF quality measures for nearly 20 years, there are no malnutrition-specific quality measures for SNFs and very few published nutrition-focused QIPs in SNFs. This represents an important care gap that should be addressed to improve resident health outcomes as SNFs more fully move to a value-based care model.
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Affiliation(s)
- Mary Beth Arensberg
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA;
- Correspondence:
| | - Cory Brunton
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA;
| | | | - Scott Bolhack
- The Wound Care Center at Northwest Hospital, Tucson, AZ 85741, USA;
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Hewko SJ. Individual-Level Factors are Significantly More Predictive of Employee Innovativeness Than Job-Specific or Organization-Level Factors: Results From a Quantitative Study of Health Professionals. Health Serv Insights 2022; 15:11786329221080039. [PMID: 35221693 PMCID: PMC8874207 DOI: 10.1177/11786329221080039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/18/2022] [Indexed: 12/14/2022] Open
Abstract
Individual innovativeness is particularly indispensable among health professionals. The healthcare environment is complex and its knowledge workers must continually adapt to change and be comfortable with ambiguity. The objective of this study was to determine the relative importance of individual, job-specific, and organizational factors on innovative output of health professionals. Employed Canadian Registered Dietitians (n = 237) completed an online survey incorporating relevant validated tools, including the 10-item Big Five Inventory and the Alberta Context Tool. Factors were classified by level and introduced in blocks to a multivariate linear regression model, with the outcome of self-reported innovative output. Factors included in the model explained 44% of variation in self-reported innovative output. Although all blocks contributed significantly to the model, minimal variation was explained by factors at the job-specific (4%) and organizational levels (4%). Factors at the individual level most predictive of innovative output were role innovation, the personality trait of conscientiousness and voluntary membership in a professional association. To encourage employee innovativeness, health administrators, and managers of health professionals should consider how best to incorporate screens for individual-level indicators of innovative output (eg, personality tests) in their institutional hiring and selection processes.
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Affiliation(s)
- Sarah J Hewko
- Sarah J Hewko, Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, HSB 316, 550 University Avenue, Charlottetown, PE C1A 4N3, Canada.
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5
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Cruz PLM, Soares BLDM, da Silva JE, Lima E Silva RRD. Clinical and nutritional predictors of hospital readmission within 30 days. Eur J Clin Nutr 2022; 76:244-250. [PMID: 34040200 DOI: 10.1038/s41430-021-00937-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/10/2021] [Accepted: 04/29/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES Identify clinical, sociodemographic, and nutritional predictors of hospital readmission within 30 days. SUBJECTS/METHODS A longitudinal study was conducted with patients hospitalised at a public institution in Recife, Brazil. Sociodemographic (age, sex, race, and place of residence), clinical (diagnosis, comorbidities, medications, polypharmacy, hospital outcome, hospital stay, and occurrence of readmission within 30 days), and nutritional (% of weight loss, body mass index, arm circumference [AC], and calf circumference [CC]) characteristics were collected from the nutritional assessment files and patient charts. Nutritional risk was determined using the 2002 Nutritional Risk Screening tool and the diagnosis of malnutrition was based on the GLIM criteria. RESULTS The sample was composed of 252 patients, 58 (23.0%; CI95%: 17.2-28.8%) of whom were readmitted within 30 days after discharge from hospital, 135 (53.5%; CI95%: 46.7-60.5%) were at nutritional risk and 107 (42.4%; CI95%: 35.6-49.3%) were malnourished. In the bivariate analysis, polypharmacy, nutritional risk, malnutrition, low AC, and low CC were associated with readmission. In the multivariate analysis, low CC was considered an independent risk factor, increasing the likelihood of hospital readmission nearly fourfold. In contrast, the absence of polypharmacy was a protective favour, reducing the likelihood of readmission by 81%. CONCLUSIONS The use of six medications or more and low calf circumference are risk factors for hospital readmission within 30 days after discharge.
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Affiliation(s)
- Paula Luiza Menezes Cruz
- Posgraduate Program in Clinical Nutrition - Institute of Biological Sciences/University of Pernambuco, Recife-PE, Brazil.
| | - Bruna Lúcia de Mendonça Soares
- Posgraduate Program in Nutrition - Federal University of Pernambuco, Recife-PE, Brazil.,Hospital da Restauração Governador Paulo Guerra, Recife-PE, Brazil
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Madril P, Golian P, Nahikian-Nelms M, Hinton A, Hart PA, Roberts KM. Identification of Malnutrition Risk Using Malnutrition Screening Tool in an Ambulatory Pancreas Clinic. Pancreas 2022; 51:94-99. [PMID: 35195601 PMCID: PMC8887787 DOI: 10.1097/mpa.0000000000001954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this project was to assess malnutrition risk in a well-defined cohort of pancreatic diseases. METHODS We performed a retrospective, cross-sectional study of 401 subjects with available malnutrition screening tool scores who received care at a single outpatient pancreas clinic during a 6-month study period. Univariate analyses were performed to compare demographic, anthropometric, symptoms/diseases, and risk for malnutrition characteristics across 3 strata of diseases: acute pancreatitis (n = 141), chronic pancreatitis (n = 193), and other pancreatic diagnoses (n = 67). RESULTS A total of 18% of subjects were identified as at risk for malnutrition, including 25% who reported involuntary weight loss and/or decreased appetite. Subjects categorized as at risk for malnutrition were more likely to have gastrointestinal symptoms. Although the nutrition consultation rates were higher in subjects at risk for malnutrition (P = 0.03), 66% did not receive a clearly indicated dietary evaluation or management recommendations. One fifth of all patients in an ambulatory pancreas clinic are identified as at risk for malnutrition using a simple, validated tool. CONCLUSIONS The majority of patients at increased risk for nutritional complications did not receive nutritional recommendations.
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Affiliation(s)
- Peter Madril
- From the School of Health and Rehabilitation Sciences, The Ohio State University
| | - Paige Golian
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | | | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH
| | - Philip A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Kristen M Roberts
- From the School of Health and Rehabilitation Sciences, The Ohio State University
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Lengfelder L, Mahlke S, Moore L, Zhang X, Williams G, Lee J. Prevalence and impact of malnutrition on length of stay, readmission, and discharge destination. JPEN J Parenter Enteral Nutr 2021; 46:1335-1342. [PMID: 34967019 DOI: 10.1002/jpen.2322] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies indicate one in three hospitalized patients are malnourished upon admission, however, the documented malnutrition rate in acute care hospitals is often lower. This study measured prevalence of malnutrition upon admission and correlated the relationship among malnutrition status, length of stay (LOS), discharge disposition, and readmission rate. MATERIALS AND METHODS A prospective observational cohort study was performed across nine tertiary care hospitals in Houston, Texas. Registered Dietitians screened patients age ≥18 within 24 hours of admission for 2 consecutive days per hospital. Malnourished patients were diagnosed using a modified version of 2012 Consensus Statement from the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. Data collected included demographics, LOS, discharge disposition, and 30-day re-admission status. RESULTS In 416 patients, 31.7% were malnourished upon admission. Malnourished patients were significantly older (67.8 vs 57.6 years, P<.001) and had a lower BMI (26.2 vs 32.4 kg/m2 , P<.001) than nonmalnourished patients. Malnourished patients had higher odds of having a LOS ≥3 days (2.38 [95% CI 1.45-3.88], P<.001) and higher odds of readmitting within 30 days (2.28 [95% CI 1.26-4.12], P<.006) when compared to nonmalnourished patients. There were no significantly different clinical outcomes between moderately and severely malnourished groups. CONCLUSION The study successfully utilized the modified AND-ASPEN criteria to show that approximately one in three patients presented with malnutrition upon admission. Malnourished patients were more likely to have longer LOS and more likely to be readmitted within 30 days. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Sarah Mahlke
- Memorial Hermann Health System, Houston, Texas, USA
| | - Lynn Moore
- Memorial Hermann Health System, Houston, Texas, USA
| | - Xu Zhang
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - George Williams
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Jenny Lee
- Memorial Hermann Health System, Houston, Texas, USA
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8
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Lam NV, Sulo S, Nguyen HA, Nguyen TN, Brunton C, Duy NN, Ngoc Bui MT, Nguyen HT, Vu TT, Truong QB, Nguyen HB. High prevalence and burden of adult malnutrition at a tertiary hospital: An opportunity to use nutrition-focused care to improve outcomes. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Theron M, O’Halloran S. Patients in public hospitals received insufficient food to meet daily protein and energy requirements: Cape Town Metropole, South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1997267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marieke Theron
- Division of Nutrition and Dietetics, University of Cape Town, Cape Town, South Africa
| | - Siobhan O’Halloran
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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10
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Anghel S, Kerr KW, Valladares AF, Kilgore KM, Sulo S. Identifying patients with malnutrition and improving use of nutrition interventions: A quality study in four US hospitals. Nutrition 2021; 91-92:111360. [PMID: 34274654 DOI: 10.1016/j.nut.2021.111360] [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: 02/25/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated how specific nutrition interventions were implemented at four US hospitals, compared rates of malnutrition diagnosis and assessment between physicians and registered dietitian nutritionists (RDNs), and examined how these differences affected the nutrition intervention received during patients' hospital stay. METHODS Data on patients' nutrition status and nutrition interventions were collected from 16 669 hospital inpatient records. Data on intervention utilization for patients with differing nutrition assessments and diagnoses from different health care practitioners were compared using descriptive statistics and χ2 tests. RESULTS The study found high levels of agreement between physician diagnosis and RDN assessment of malnutrition (88%). Much of this agreement related to patients identified as not malnourished. Of patients identified as malnourished by either physician diagnosis or RDN assessment, agreement was reached in 55.5% of patients. Less than half (46.3%) of patients identified as malnourished had a documented nutrition intervention. Oral nutritional supplements (ONS) were the most commonly used intervention, with 5.1% of patients receiving them. Patients identified as malnourished by physician diagnosis, but not by RDN assessment, were more likely to receive enteral and parenteral nutrition. Patients identified as malnourished by RDN assessment, but not by physician diagnosis, were more likely to have received ONS, meals and snacks, counseling, and food/nutrition-related medication management. CONCLUSION The high level of agreement on assessment and malnutrition diagnosis suggests positive levels of malnutrition care coordination at the study hospitals. However, significant room for improvement exists in providing interventions to inpatients diagnosed with malnourishment. Differences in interventions may reflect dissimilar approaches commonly used by different practitioners and should be a topic of future study.
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Affiliation(s)
- Sharen Anghel
- Overlook Medical Center, Atlantic Health System, Summit, New Jersey, United States
| | - Kirk W Kerr
- Abbott Nutrition, Columbus, Ohio, United States.
| | | | | | - Suela Sulo
- Abbott Nutrition, Columbus, Ohio, United States
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Pimiento JM, Evans DC, Tyler R, Barrocas A, Hernandez B, Araujo-Torres K, Guenter P. Value of nutrition support therapy in patients with gastrointestinal malignancies: a narrative review and health economic analysis of impact on clinical outcomes in the United States. J Gastrointest Oncol 2021; 12:864-873. [PMID: 34012673 DOI: 10.21037/jgo-20-326] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Malnutrition, particularly under-nutrition, is highly prevalent among adult patients with a diagnosis of gastrointestinal (GI) cancer and negatively affects patient outcomes. Malnutrition is associated with clinical and surgical complications for patients undergoing therapy for GI cancers and the costs associated with those complications is a high burden for the US health system. Our objective was to identify high-quality evidence for nutrition support interventions associated with cost savings for patient care, followed by a complex economic value analysis to project cost savings for the US health system. A narrative literature search was conducted in which combined keywords in the areas of therapeutic nutrition (nutrition, malnutrition), a specific therapeutic area [GI cancer (esophageal, gastric, gallbladder, pancreatic, liver/hepatic, small and large intestine, colorectal)], and clinical outcomes and healthcare cost, to look for nutrition interventions that could significantly improve clinical outcomes. Medicare claims data were then analyzed using the findings of these identified studies and this modeling exercise supported identifying the cost and healthcare resource utilization implications of specific populations to determine the impact of nutrition support on reducing these costs as reflected in the summary of the evidence. Eight studies were found that provided clinical outcomes and health cost savings data, 2 of those had the strongest level of evidence and were used for Value Analysis calculations. Nutrition interventions such as oral diet modifications, enteral nutrition (EN) supplementation, and parenteral nutrition (PN) have been studied especially in the peri-operative setting. Specifically, peri-operative immunonutrition administration and utilization of enhanced recovery pathways after surgery have been associated with significant improvement in postoperative complications and decreased length of hospital stay (LOS). Utilizing economic modeling of Medicare claims data from GI cancer patients, potential annual cost savings of $242 million were projected by the widespread adoption of these interventions. Clinical outcomes can be improved with the use of nutrition interventions in patients with GI cancers. Healthcare costs can be reduced as a result of fewer in-hospital complications and shorter lengths of hospital stay. The application of nutrition intervention provides a positive clinical and economic value proposition to the healthcare system for patients with GI cancers.
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Affiliation(s)
- Jose M Pimiento
- Gastrointestinal Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David C Evans
- Ohio Health Trauma and Surgical Services, Columbus OH, USA
| | - Renay Tyler
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Albert Barrocas
- Surgery Department, Tulane School of Medicine, New Orleans, LA, USA
| | | | | | - Peggi Guenter
- American Society for Parenteral Nutrition, Silver Spring, MD, USA
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Murray RD, Kerr KW, Brunton C, Williams JA, DeWitt T, Wulf KL. A First Step Towards Eliminating Malnutrition: A Proposal for Universal Nutrition Screening in Pediatric Practice. NUTRITION AND DIETARY SUPPLEMENTS 2021. [DOI: 10.2147/nds.s287981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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13
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Sulo S, Gramlich L, Benjamin J, McCauley S, Powers J, Sriram K, Mitchell K. Nutrition Interventions Deliver Value in Healthcare: Real-World Evidence . NUTRITION AND DIETARY SUPPLEMENTS 2020. [DOI: 10.2147/nds.s262364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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14
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Kamel AY, Rosenthal MD, Citty SW, Marlowe BL, Garvan CS, Westhoff L, Marker PS, Croft CA, Brakenridge SC, Efron PA, Mohr A, Moore FA. Enteral Nutrition Administration Record Prescribing Process Using Computerized Order Entry: A New Paradigm and Opportunities to Improve Outcomes in Critically Ill Patients. JPEN J Parenter Enteral Nutr 2020; 45:507-517. [PMID: 32384191 DOI: 10.1002/jpen.1870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/29/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prevalence of malnutrition has been reported in 60% of hospitalized and up to 78% of patients admitted to intensive care units. Malnutrition has been associated with complications, such as infection, increased hospital length of stay, morbidity, and mortality. Nutritional support has been shown to reduce avoidable readmissions, pressure ulcers, malpractice claims, and hospital costs. Creating a new electronic nutrition administration record (ENAR) with a linked nutrition tab within the electronic health record (EHR) would promote enhanced patient outcomes by improving adherence to established institutional enteral nutrition (EN) protocols and achieving early energy goals. Additionally, it would enable a clear and standardized method for documentation and administration of EN therapy. METHODS The multidisciplinary nutrition support team was established and met on a weekly basis to discuss strategies and barriers, identify stakeholders, evaluate the current state, and establish a process and workflow from the point of order entry, delivery, administration, and electronic documentation of orders of EN supplements. The aim of this article is to describe a systematic approach and process of creating a new ENAR with a linked nutrition tab in the EHR, and to illustrate the order panel built and lessons learned from the process. RESULTS A separate nutrition tab was created in the EHR with minimal disruption in patient care and end-users' positive feedback for the new order panel. CONCLUSION ENAR allows for easier data collection and promotes nutrition-related research that may result in enhanced patient care. Utilizing technology to build a full ENAR would result in optimized patient care and safety.
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Affiliation(s)
- Amir Y Kamel
- Department of Pharmacy, UF Health Shands Hospital, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Martin D Rosenthal
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sandra W Citty
- Department of Nursing, College of Nursing, University of Florida Health Hospital, Gainesville, Florida, USA
| | | | - Cynthia S Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Lynn Westhoff
- Department of Nursing, UF Health Shands, College of Nursing, Gainesville, Florida, USA
| | - Peggy S Marker
- Department of Nursing, UF Health Shands, College of Nursing, Gainesville, Florida, USA
| | - Chasen A Croft
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Scott C Brakenridge
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Philip A Efron
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Alicia Mohr
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Frederick A Moore
- Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
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15
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Pratt KJ, Hernandez B, Blancato R, Blankenship J, Mitchell K. Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital. BMJ Open Qual 2020; 9:e000735. [PMID: 32213547 PMCID: PMC7170540 DOI: 10.1136/bmjoq-2019-000735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 02/14/2020] [Accepted: 03/01/2020] [Indexed: 01/21/2023] Open
Abstract
As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition is associated with an elevated need for continued medical interventions, higher costs of care and increased patient safety risks. Tampa General Hospital (TGH), a large teaching hospital in the southeastern USA, initiated a project to improve the quality of patient care at its institution. They did this first by focusing on improving the care quality for their malnourished patients (or patients who were at risk of malnourishment) and by using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality. The aim of this study was to evaluate the impact of quality improvement interventions on patient length of stay (LOS), infection rates and readmissions, particularly for malnourished patients. The structure of the MQii and the use of the MQii Toolkit helped staff members identify problems and systematically engage in quality improvement processes. Using the MQii Toolkit, TGH implemented a multipronged approach to improving the treatment of malnourished patients that involved creating interdisciplinary teams of staff and identifying gaps in care that could be improved through a series of changes to hospital-wide clinical workflows. They enhanced interdisciplinary coordination through increased dietitian engagement, the use of electronic health record alerts and new surgical protocols. These interventions lasted 8 months in 2016 and data reported here were collected from 985 patients before the interventions (2015) and 1046 patients after the interventions (2017). The study examines how these process changes affected LOS, infection rates and readmissions at TGH. Following implementation of these quality improvement processes, patients who were malnourished or at risk of malnutrition had a 25% reduction in LOS (from 8 to 6 days, p<0.01) and a 35.7% reduction in infection rates (from 14% to 9%, p<0.01). No statistically significant changes in readmission rates were observed. This study adds to a growing body of literature on quality improvement processes hospitals can undertake to better identify and treat malnourished patients. Hospitals and health systems can benefit from adopting similar institution-wide, quality improvement projects, while policy-makers' support for such programmes can spur more rapid uptake of nutrition-focused initiatives across care delivery settings.
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Affiliation(s)
- Kelsey Jones Pratt
- Center for Healthcare Transformation, Avalere Health, Washington, DC, USA
| | - Beverly Hernandez
- Clinical Nutrition Services, Tampa General Hospital, Tampa, Florida, USA
| | | | - Jeanne Blankenship
- Policy Initiatives and Advocacy, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Kristi Mitchell
- Center for Healthcare Transformation, Avalere Health, Washington, DC, USA
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Ohnuma T, Krishnamoorthy V, Raghunathan K, Williams DGA, Sulo S, Hegazi R, Wischmeyer PE. Overcoming confounding by indication in nutrition research using electronic healthcare data. Clin Nutr 2020; 39:985-987. [PMID: 32061371 DOI: 10.1016/j.clnu.2020.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Tetsu Ohnuma
- CAPER Unit Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Vijay Krishnamoorthy
- CAPER Unit Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Karthik Raghunathan
- CAPER Unit Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - David G A Williams
- CAPER Unit Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Paul E Wischmeyer
- CAPER Unit Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
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17
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Meehan A, Partridge J, Jonnalagadda SS. Clinical and Economic Value of Nutrition in Healthcare: A Nurse's Perspective. Nutr Clin Pract 2019; 34:832-838. [PMID: 31544300 DOI: 10.1002/ncp.10405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In the US healthcare system, malnutrition is a common condition, yet it remains underreported and underdiagnosed. The financial costs of disease-associated malnutrition are substantial; hospital-acquired conditions, readmissions, and prolonged lengths of stay are reported to cost as much as $150 billion per year. By contrast, nutrition-focused quality improvement programs for inpatients can help reduce the negative impact of disease-associated malnutrition. Such programs include systematic screening for malnutrition risk on admission, timely malnutrition diagnoses, and prompt nutrition interventions, which have been shown to lower rates of hospital-acquired infections, shorten lengths of stay, reduce readmissions, and lessen costs of care. Nurses are ideally positioned to play critical roles in nutrition-related care-screening for malnutrition on admission, monitoring for and addressing conditions that impede nutrition intake, and ensuring that prescribed nutrition interventions are delivered and administered or consumed. Such nursing support of multidisciplinary nutrition care contributes to better patient outcomes at lower costs.
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Affiliation(s)
- Anita Meehan
- Cleveland Clinic Akron General, Akron, Ohio, USA
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18
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In response to the director letter "Polyphenols, Mediterranean diet, and colon cancer". Support Care Cancer 2019; 27:4037. [PMID: 31468194 DOI: 10.1007/s00520-019-05011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
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The Association between Oral Nutritional Supplements and 30-Day Hospital Readmissions of Malnourished Patients at a US Academic Medical Center. J Acad Nutr Diet 2019; 119:1168-1175. [DOI: 10.1016/j.jand.2019.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/20/2018] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
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