1
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Correia MITD, Sulo S, Brunton C, Sulz I, Rodriguez D, Gomez G, Tarantino S, Hiesmayr M. Prevalence of malnutrition risk and its association with mortality: nutritionDay Latin America survey results. Clin Nutr 2021; 40:5114-5121. [PMID: 34461585 DOI: 10.1016/j.clnu.2021.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes. METHODS On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay. RESULTS The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P < 0.001) for patients eating one-quarter of their meal (compared with those who ate the full meal), increasing to 6.6 (95% CI [5.02, 8.7]; P < 0.0001) for patients who ate none of the food offered. CONCLUSIONS Based on compilation of nDay surveys throughout Latin America, 2 of every 5 hospitalized patients were at risk for malnutrition. The associated risk for hospital mortality was up to 6-fold higher among patients who ate little or none of their meal on nDay. This high prevalence showed scant improvement over rates two decades ago-a compelling rationale for new focus on nutrition education and training of professionals in acute care settings.
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Affiliation(s)
- M Isabel T D Correia
- Department of Surgery, Universidade Federal de Minas Gerais Medical School, Belo Horizonte, Brazil
| | | | | | - Isabella Sulz
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems Medical University Vienna, Vienna, Austria
| | - Dolores Rodriguez
- Clinical Nutrition Department, SOLCA Cancer Hospital, Guayaquil, Ecuador
| | | | - Silvia Tarantino
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems Medical University Vienna, Vienna, Austria
| | - Michael Hiesmayr
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems Medical University Vienna, Vienna, Austria
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2
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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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3
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical Nutrition and Human Rights. An International Position Paper. Nutr Clin Pract 2021; 36:534-544. [PMID: 34013590 DOI: 10.1002/ncp.10667] [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] [Indexed: 01/01/2023] Open
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country, Bogota, Colombia
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, Tours, France
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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4
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Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical nutrition and human rights. An international position paper. Clin Nutr 2021; 40:4029-4036. [PMID: 34023070 DOI: 10.1016/j.clnu.2021.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, El Bosque University, Bogotá, Colombia.
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, LA, USA.
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand.
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica Del Country, Bogota, Colombia.
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de La Universidad de Chile, Santiago, Chile.
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, France.
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
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5
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Valladares AF, Kilgore KM, Partridge J, Sulo S, Kerr KW, McCauley S. How a Malnutrition Quality Improvement Initiative Furthers Malnutrition Measurement and Care: Results From a Hospital Learning Collaborative. JPEN J Parenter Enteral Nutr 2021; 45:366-371. [PMID: 32282948 PMCID: PMC7984333 DOI: 10.1002/jpen.1833] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Malnutrition in hospitalized patients can adversely affect health outcomes and increase the cost of care. Real-world strategies are needed for prompt identification and treatment of patients at risk of malnutrition. OBJECTIVES The aim of this quality improvement (QI) study was to measure the impact of a nutrition-focused program on the malnutrition care processes of participating hospitals. Secondary objectives were to determine whether improvements in these nutrition-related processes reduced hospital readmissions and length of stay (LOS) in patients ≥65 years. METHODS A group of 27 US hospitals ("The Collaborative") implemented the Malnutrition Quality Improvement Initiative (MQii), as guided by a Malnutrition QI Toolkit and 4 electronic clinical quality measures (eCQMs), including (1) nutrition screening; (2) nutrition assessment following detection of malnutrition risk; (3) nutrition care plan for patients identified as malnourished after completed nutrition assessment; and (4) documentation of malnutrition diagnoses. Multivariate analyses identified the variables best correlated with patient outcomes. RESULTS Improvements were observed for all 4 eCQMs. The greatest improvements were achieved as a result of timely nutrition assessment (P = .06) and malnutrition diagnosis (P = .02). Patients ≥65 years with a malnutrition diagnosis and nutrition care plan had a 24% lower likelihood of 30-day readmission but a longer mean LOS than did those without a care plan. CONCLUSIONS In this study, the implementation of MQii practices significantly improved the identification of malnutrition. The prompt identification and treatment of patients at malnutrition risk can improve patient care and health, as well as reduce costly readmissions.
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Affiliation(s)
- Angel F. Valladares
- Senior Manager, The Center for Healthcare TransformationAvalere HealthWashingtonDCUSA
| | - Karl M. Kilgore
- Health Economics and Advanced AnalyticsAvalere HealthWashingtonDCUSA
| | - Jamie Partridge
- Global Scientific AffairsAbbott Nutrition R&DColumbusOhioUSA
| | - Suela Sulo
- Global Health Economics and Outcomes ResearchAbbott NutritionAbbott ParkIllinoisUSA
| | - Kirk W. Kerr
- Global Health Economics and Outcomes ResearchAbbott NutritionColumbusOhioUSA
| | - Sharon McCauley
- Quality ManagementThe Academy of Nutrition and DieteticsChicagoIllinoisUSA
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6
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Toulson Davisson Correia MI, Castro M, Oliveira Toledo D, Farah D, Sansone D, Morais Andrade TR, Tannus Branco de Araújo G, Fonseca MCM. Nutrition Therapy Cost‐Effectiveness Model Indicating How Nutrition May Contribute to the Efficiency and Financial Sustainability of the Health Systems. JPEN J Parenter Enteral Nutr 2020; 45:1542-1550. [PMID: 33241592 PMCID: PMC8697995 DOI: 10.1002/jpen.2052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
Background Method Results Conclusion
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Affiliation(s)
| | | | | | - Daniela Farah
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
| | - Dayan Sansone
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
| | - Tereza Raquel Morais Andrade
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
| | - Gabriela Tannus Branco de Araújo
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
| | - Marcelo Cunio Machado Fonseca
- Women's Health Technology Assessment Center Department of Gynecology Federal University of São Paulo, Medical School São Paulo Brazil
- Axia.Bio Life Sciences São Paulo Brazil
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7
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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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8
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Sulo S, Lanctin D, Feldstein J, Schwander B, Partridge J, Landow W, Zöllner YF. Budget Impact Analysis of a Home-Based Nutrition Program for Adults at Risk for Malnutrition. AMERICAN HEALTH & DRUG BENEFITS 2020; 13:95-101. [PMID: 32699570 PMCID: PMC7370826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hospital-based, nutrition-focused interventions have significantly lowered the cost-associated burden of poor nutrition through a reduction in healthcare resource utilization (HCRU). However, for patients at risk for poor nutrition who receive nutritional care at home, limited evidence exists on the economic impact of nutrition-focused interventions. OBJECTIVE To estimate the 30-day cost-savings associated with an at-home nutrition-focused quality improvement program in the postacute care setting for patients at risk for poor nutrition from the perspective of a hospital system. METHODS We compared the HCRU of 1546 patients enrolled in a quality improvement program during 1 year versus 7413 patients in a pre-program historical cohort who received care during the 1 year before the quality improvement program implementation. The analysis included the number of 30-day hospitalizations, emergency department and outpatient visits for both cohorts, and the associated costs. The main analysis included the fixed and variable costs for the program, and the costs of oral nutritional supplement and delivery. The costs for hospitalization, emergency department, and outpatient visit costs were based on the 2013 Healthcare Cost and Utilization Project and Medical Expenditure Panel Survey. RESULTS Based on the 2013 survey, the baseline costs for hospitalization, emergency department, and outpatient visit costs were $18,296, $1312, and $535, respectively. Our health economic analysis about the 30-day overall HCRU has shown that the quality improvement program group resulted in a total cost-savings of $2,408,668 for the 1546 patients in the program and a net savings of $1558 per patient compared with the costs for the pre-quality improvement program historical cohort. CONCLUSION The use of a nutrition-focused quality improvement program led to significant 30-day cost-savings, by reducing HCRU for adults who received nutritional-based care at home. The improvements in HCRU highlight the importance of implementing nutrition-focused quality improvement programs for hospital systems that provide care for patients who are at risk for poor nutrition across a variety of care settings.
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Affiliation(s)
- Suela Sulo
- Director, Health Economics & Outcomes Research (HEOR), Abbott Nutrition, Columbus, OH
| | | | - Josh Feldstein
- President and Chief Executive Officer, CAVA, LLC, Northampton, MA
| | - Bjoern Schwander
- General Manager, AHEAD GmbH-Agency for Health Economic Assessment and Dissemination, Loerrach, Germany
| | - Jamie Partridge
- Director, Global HEOR & Health Policy, Abbott Nutrition, Columbus
| | - Wendy Landow
- Director, Operations, Advocate Health Care, Downers Grove, IL
| | - York F Zöllner
- Professor, Health Economics, Medical School Hamburg, Germany
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9
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Williams DGA, Villalta E, Aronson S, Murray S, Blitz J, Kosmos V, Wischmeyer PE. Tutorial: Development and Implementation of a Multidisciplinary Preoperative Nutrition Optimization Clinic. JPEN J Parenter Enteral Nutr 2020; 44:1185-1196. [PMID: 32232882 PMCID: PMC7540666 DOI: 10.1002/jpen.1824] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/25/2020] [Indexed: 12/29/2022]
Abstract
Although much is known about surgical risk, little evidence exists regarding how best to proactively address preoperative risk factors to improve surgical outcomes. Preoperative malnutrition is a widely prevalent and modifiable risk factor in patients undergoing surgery. Malnutrition prior to surgery portends significantly higher postoperative mortality, morbidity, length of stay, readmission rates, and hospital costs. Unfortunately, perioperative malnutrition is poorly screened for and remains largely unrecognized and undertreated—a true “silent epidemic” in surgical care. To better address this silent epidemic of surgical nutrition risk, here we describe the rationalization, development, and implementation of a multidisciplinary, registered dietitian–driven, preoperative nutrition optimization clinic program designed to improve perioperative outcomes and reduce cost. Implementation of this novel Perioperative Enhancement Team (POET) Nutrition Clinic required a collaboration among many disciplines, as well as an identified need for multidimensional scheduling template development, data tracking systems, dashboard development, and integration of electronic health records. A structured malnutrition risk score (Perioperative Nutrition Screen score) was developed and is being validated. A structured malnutrition pathway was developed and is under study. Finally, the POET Nutrition Clinic has established a novel role for a perioperative registered dietitian as the integral point person to deliver perioperative nutrition care. We hope this structured model of perioperative nutrition assessment and optimization will allow for wide implementation and generalizability in other centers worldwide to improve recognition and treatment of perioperative nutrition risk.
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Affiliation(s)
- David G A Williams
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Solomon Aronson
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.,Population Health Science, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sutton Murray
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jeanna Blitz
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Paul E Wischmeyer
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
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10
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Mistiaen P, Van den Heede K. Nutrition Support Teams: A Systematic Review. JPEN J Parenter Enteral Nutr 2020; 44:1004-1020. [PMID: 32181928 DOI: 10.1002/jpen.1811] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The concept of a nutrition support team (NST) was first introduced at the end of the 20th century in the US and Europe. Expected benefits include reduced (inappropriate) prescription of (par)enteral nutrition; however, to the authors' knowledge, no recent review has assessed the effectiveness of NSTs. Therefore, this systematic review evaluated the effectiveness of NSTs with respect to the prevalence of adult patients receiving (par)enteral nutrition. METHODS Five literature databases were searched and completed by citing searches. Studies on NSTs that were published between 2000 and 2018 in Western countries, applied a comparative design, and contained at least outcome data on the prevalence of (par)enteral nutrition were included. Analyses were mainly descriptive because of high heterogeneity that prevented meta-analyses. RESULTS The 27 included studies mainly originated from the UK and US. Only 1 of the included studies was a randomized trial; the other studies had a pre-post design (n = 17) or compared groups in a nonrandomized way. All but 2 studies were performed in acute care hospitals, and 5 studies focused only on intensive care patients. There was conflicting evidence of whether NSTs lead to reduction or increase in patients starting parenteral nutrition (PN); however, weak evidence suggested that NSTs might lead to an increase in the ratio of enteral nutrition to PN use and might decrease inappropriate PN use. CONCLUSION Although almost all studies concluded in favor of NSTs, the evidence base is weak and insufficient because of a lack of well-designed studies and successful outcomes.
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11
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Choueiry G, Fattouh N, Hallit R, Kazour F, Hallit S, Salameh P. Nutritional Status of Lebanese Hospitalized Patients With Chronic Disease: A Cross-Sectional Study. Hosp Pharm 2019; 56:102-108. [PMID: 33790485 DOI: 10.1177/0018578719867664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In a hospitalized setting, malnutrition is known to increase patient's mortality and lower the quality of life; therefore, it is essential to detect such cases and intervene at the earliest possible. The goal of this study is to estimate the rate of malnutrition in hospitalized Lebanese patients, explore its association with different factors, and create a simple tool to detect patients at high risk of malnutrition. Methods: One hundred and fifty Lebanese hospitalized patients, suffering at least from one chronic disease, were randomly chosen from Centre Hospitalier Universitaire Notre Dame de Secours (CHU-NDS) hospital. The Mini Nutritional Assessment (MNA) score was used to assess nutritional status. Results: A total of 34.7% of patients in our sample were at risk of malnutrition and 9.3% were malnourished. A higher risk of malnutrition was found in patients with a low body mass index, who were physically inactive or admitted to the hospital more than once in the past 6 months. The nutritional status was not associated with certain chronic diseases more than others. We designed a simple decision tree model based only on 3 questions to detect patients at high risk of malnutrition/malnourished. This tool has a sensitivity of 62% and a specificity of 77%. Conclusion: The prevalence found in our study was comparable with previous data. However, factors associated with poor nutritional status were somewhat different. Further studies are needed to validate our screening tool and to examine the effect of specific diseases on malnutrition on a larger scale.
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Affiliation(s)
- Georges Choueiry
- Faculty of Pharmacy Lebanese University, Hadath, Lebanon.,Department of Epidemiology & Biostatistics, Faculty of Public Health Lebanese University, Fanar, Lebanon
| | - Nour Fattouh
- Faculty of Medicine and Medical Sciences Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Francois Kazour
- Faculty of Philosophy and Human Sciences, Holy Spirit University, (USEK), Jounieh, Lebanon.,Faculty of Sciences, Lebanese University, Fanar, Lebanon.,Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,INSERM U930, équipe 4 "Troubles affectifs", Université François-Rabelais de Tours, Tours, France.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Pascale Salameh
- Faculty of Pharmacy Lebanese University, Hadath, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine, Lebanese University, Hadat, Lebanon
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12
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Clinical and economic outcomes associated with malnutrition in hospitalized patients. Clin Nutr 2019; 38:1310-1316. [DOI: 10.1016/j.clnu.2018.05.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/25/2018] [Indexed: 11/22/2022]
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13
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Gomes MMA, Silva JM, Silva Ferreira ÁR, Vasconcelos Generoso S, Correia MITD. Implementing Quality Assessment Is Fundamental to Guarantee Optimal Nutrition Therapy. JPEN J Parenter Enteral Nutr 2019; 44:274-281. [DOI: 10.1002/jpen.1600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | - Jessica Moreira Silva
- Nutrition Post Graduation Program Nursing School Universidade Federal de Minas Gerais
| | | | | | - Maria Isabel Toulson Davisson Correia
- Surgical Department, and Applied Sciences in Surgery and Ophtalmology Post Graduation Program Medical School, and Nutrition Post Graduation Program Nursing School Universidade Federal de Minas Gerais Belo Horizonte Minas Gerais Brazil
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14
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Hugo C, Isenring E, Miller M, Marshall S. Cost-effectiveness of food, supplement and environmental interventions to address malnutrition in residential aged care: a systematic review. Age Ageing 2018; 47:356-366. [PMID: 29315355 DOI: 10.1093/ageing/afx187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/22/2017] [Indexed: 12/18/2022] Open
Abstract
Background observational studies have shown that nutritional strategies to manage malnutrition may be cost-effective in aged care; but more robust economic data is needed to support and encourage translation to practice. Therefore, the aim of this systematic review is to compare the cost-effectiveness of implementing nutrition interventions targeting malnutrition in aged care homes versus usual care. Setting residential aged care homes. Methods systematic literature review of studies published between January 2000 and August 2017 across 10 electronic databases. Cochrane Risk of Bias tool and GRADE were used to evaluate the quality of the studies. Results eight included studies (3,098 studies initially screened) reported on 11 intervention groups, evaluating the effect of modifications to dining environment (n = 1), supplements (n = 5) and food-based interventions (n = 5). Interventions had a low cost of implementation (<£2.30/resident/day) and provided clinical improvement for a range of outcomes including weight, nutritional status and dietary intake. Supplements and food-based interventions further demonstrated a low cost per quality adjusted life year or unit of physical function improvement. GRADE assessment revealed the quality of the body of evidence that introducing malnutrition interventions, whether they be environmental, supplements or food-based, are cost-effective in aged care homes was low. Conclusion this review suggests supplements and food-based nutrition interventions in the aged care setting are clinically effective, have a low cost of implementation and may be cost-effective at improving clinical outcomes associated with malnutrition. More studies using well-defined frameworks for economic analysis, stronger study designs with improved quality, along with validated malnutrition measures are needed to confirm and increase confidence with these findings.
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Affiliation(s)
- Cherie Hugo
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland 4226, Australia
| | - Elisabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland 4226, Australia
| | - Michelle Miller
- Dean of People and Resources at Flinders University, Australia
| | - Skye Marshall
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland 4226, Australia
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Jain R, Denlinger CS. Incorporating Weight Management into Clinical Care for Cancer Survivors: Challenges, Opportunities, and Future Directions. Obesity (Silver Spring) 2017; 25 Suppl 2:S27-S29. [PMID: 29086512 PMCID: PMC5744874 DOI: 10.1002/oby.22016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/22/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Rishi Jain
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
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16
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Hyeda A, Costa ÉSMD. Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome. EINSTEIN-SAO PAULO 2017; 15:192-199. [PMID: 28767918 PMCID: PMC5609616 DOI: 10.1590/s1679-45082017gs4002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/04/2017] [Indexed: 11/29/2022] Open
Abstract
Objective To conduct an economic analysis of enteral and parenteral diet costs according to the type of disease and outcome (survivors versus deaths). Methods It is a cross-sectional, observational, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare insurance provider in the Southern region of Brazil. Results We analyzed 301 hospital accounts of individuals who used enteral and parenteral diets. The total cost of the diet was 35.4% of hospital account total costs. The enteral modality accounted for 59.8% of total dietary costs. The major costs with diets were observed in hospitalizations related to infections, cancers and cerebro-cardiovascular diseases. The major costs with parenteral diet were with admissions related by cancers (64.52%) and dementia syndromes (46.17%). The highest ratio between total diet costs with the total of hospital account costs was in dementia syndromes (46.32%) and in cancers (41.2%). The individuals who died spent 51.26% of total of hospital account costs, being 32.81% in diet (47.45% of total diet value and 58.81% in parenteral modality). Conclusion Enteral and parenteral nutritional therapies account for a significant part of the costs with hospitalized individuals, especially in cases of cancers and dementia syndromes. The costs of parenteral diets were higher in the group of patients who died.
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Affiliation(s)
- Adriano Hyeda
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Instituto Superior de Administração e Economia, Fundação Getúlio Vargas, Curitiba, PR, Brazil
| | - Élide Sbardellotto Mariano da Costa
- Universidade Federal do Paraná, Curitiba, PR, Brazil.,Instituto Superior de Administração e Economia, Fundação Getúlio Vargas, Curitiba, PR, Brazil
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Sulo S, Feldstein J, Partridge J, Schwander B, Sriram K, Summerfelt WT. Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients. AMERICAN HEALTH & DRUG BENEFITS 2017; 10:262-270. [PMID: 28975010 PMCID: PMC5620506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. OBJECTIVES To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. METHODS The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. RESULTS As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the validation cohort. When these costs were assessed across the entire patient population enrolled in the quality improvement program, per-patient net savings of $1499 when using the baseline cohort as the comparator and savings per patient treated of $3858 when using the validated cohort as the comparator were achieved. CONCLUSION The nutrition-focused quality improvement program reduced the per-patient healthcare costs by avoiding 30-day readmissions and through reduced length of hospital stay. These clinical and economic outcomes provide a rationale for merging patient care and financial modeling to advance the delivery of value-based medicine in a malnourished hospitalized population. The use of a novel web-based budget impact model supports the integration of comparative effectiveness analytics and healthcare resource management in the hospital setting to provide optimal quality of care at a reduced overall cost.
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Affiliation(s)
- Suela Sulo
- Senior Manager, Health Economics Outcomes Research, Abbott Nutrition, Chicago, IL
| | - Josh Feldstein
- President and Chief Executive Officer, Center for Applied Value Analysis, Northampton, MA
| | - Jamie Partridge
- Director, Global Scientific Affairs, Abbott Nutrition, Columbus, OH
| | - Bjoern Schwander
- General Manager, AHEAD GmbH-Agency for Health Economic Assessment & Dissemination, Loerrach, Germany
| | - Krishnan Sriram
- Tele-Intensivist, eICU, Advocate Health Care, Downers Grove, IL
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18
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Cereda E, Klersy C, Andreola M, Pisati R, Schols JM, Caccialanza R, D'Andrea F. Cost-effectiveness of a disease-specific oral nutritional support for pressure ulcer healing. Clin Nutr 2017; 36:246-252. [DOI: 10.1016/j.clnu.2015.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/29/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
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19
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Goates S, Du K, Braunschweig CA, Arensberg MB. Economic Burden of Disease-Associated Malnutrition at the State Level. PLoS One 2016; 11:e0161833. [PMID: 27655372 PMCID: PMC5031313 DOI: 10.1371/journal.pone.0161833] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/12/2016] [Indexed: 12/22/2022] Open
Abstract
Background Disease-associated malnutrition has been identified as a prevalent condition, particularly for the elderly, which has often been overlooked in the U.S. healthcare system. The state-level burden of community-based disease-associated malnutrition is unknown and there have been limited efforts by state policy makers to identify, quantify, and address malnutrition. The objective of this study was to examine and quantify the state-level economic burden of disease-associated malnutrition. Methods Direct medical costs of disease-associated malnutrition were calculated for 8 diseases: Stroke, Chronic Obstructive Pulmonary Disease, Coronary Heart Failure, Breast Cancer, Dementia, Musculoskeletal Disorders, Depression, and Colorectal Cancer. National disease and malnutrition prevalence rates were estimated for subgroups defined by age, race, and sex using the National Health and Nutrition Examination Survey and the National Health Interview Survey. State prevalence of disease-associated malnutrition was estimated by combining national prevalence estimates with states’ demographic data from the U.S. Census. Direct medical cost for each state was estimated as the increased expenditures incurred as a result of malnutrition. Principal Findings Direct medical costs attributable to disease-associated malnutrition vary among states from an annual cost of $36 per capita in Utah to $65 per capita in Washington, D.C. Nationally the annual cost of disease-associated malnutrition is over $15.5 billion. The elderly bear a disproportionate share of this cost on both the state and national level. Conclusions Additional action is needed to reduce the economic impact of disease-associated malnutrition, particularly at the state level. Nutrition may be a cost-effective way to help address high health care costs.
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Affiliation(s)
- Scott Goates
- Abbott Nutrition, Research & Development, Columbus, Ohio, United States of America
| | - Kristy Du
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
- Abbott Nutrition, Research Park at the University of Illinois, Champaign, Illinois, United States of America
| | - Carol A. Braunschweig
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Mary Beth Arensberg
- Abbott Nutrition Products Division of Abbott, Columbus, Ohio, United States of America
- * E-mail:
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Cardenas D. What is clinical nutrition? Understanding the epistemological foundations of a new discipline. Clin Nutr ESPEN 2016; 11:e63-e66. [DOI: 10.1016/j.clnesp.2015.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
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21
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Maruthappu M, Hasan A, Zeltner T. Enablers and Barriers in Implementing Integrated Care. Health Syst Reform 2015; 1:250-256. [PMID: 31519094 DOI: 10.1080/23288604.2015.1077301] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract-The integration of medical and social care aims to address the fragmentation in patient services observed in many health care systems. Increasing rates of chronic disease and multimorbidity have drawn attention to the often significant reforms necessary to address these problems. In this article we discuss how integration may be achieved. To date there is no single best practice model or well-defined guidelines for integration. We suggest that three groups of patients with complex health needs would experience the greatest benefit: multimorbid patients with two or more chronic diseases, patients with moderate or severe mental health conditions, and the elderly. Integration has been demonstrated to achieve improvements in the coordination, quality, efficiency, and cost control of health care. Considering these benefits, a broad effort should be made to implement integrated care.
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Affiliation(s)
| | | | - Thomas Zeltner
- Department of Public Health; University of Bern ; Bern , Switzerland
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Al-Zeer O, Ozcagli TG, Uyar M. A call-to-action from the feedM.E. Middle East study group. Use of a screen-intervene-supervene strategy to address malnutrition in healthcare. Saudi Med J 2015; 36:903-10. [PMID: 26219439 PMCID: PMC4549585 DOI: 10.15537/smj.2015.8.11671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Up to 50% of hospitalized patients worldwide are malnourished or at risk of malnutrition. Guidelines recommend nutritional screening of all patients on hospital admission. Results from studies of hospitalized patients show that screening, with follow-up nutritional assessment and care when indicated, can improve patients' clinical outcomes and reduce healthcare costs. Despite compelling evidence, attention to nutritional care remains suboptimal in clinical settings worldwide. The feedM.E. Global Study Group developed a simple, stepwise Nutrition Care Pathway to facilitate best-practice nutrition care. This pathway guides clinicians to screen patients' nutritional status on hospital admission or at initiation of care; intervene promptly with nutrition care when needed; and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans. The feedM.E. Middle East Study Group seeks to extend this program to our region. We advise clinicians to adopt and adapt the Nutrition Care Pathway, bringing quality nutrition care to everyday practice.
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Affiliation(s)
- Osama Al-Zeer
- Department of Clinical Nutrition, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Pinzón Espítia OL. Evaluación económica aplicada a las unidades de soporte nutricional. REVISTA DE LA FACULTAD DE MEDICINA 2014. [DOI: 10.15446/revfacmed.v62n2.45423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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