Hospitals and healthcare teams today are breaking down silos and using advancements in medical technology to create holistic treatment plans for their patients. Yet one area that often goes overlooked is a patient's nutritional status, despite the growing body of evidence that demonstrates its positive impact on patient care and cutting hospital costs.
About one-third of patients entering the hospital are malnourished with even more becoming malnourished during their stay. Hundreds of studies over the past 40 years have proven that poor nutrition, or malnutrition, among patients impacts both health and economic outcomes. For example:
• The consequences of malnutrition can include longer hospital stays, more frequent readmissions, increased costs of care, and higher risk of complications (such as pressure ulcers, infections and falls) and mortality.
• The readmission cost, based on industry averages, is more than $11,000, almost double the costs of a well-nourished patient.
The impact of malnutrition will no doubt become more prevalent as the population ages and has more chronic diseases. About half of all adults – 117 million people – have one or more chronic health condition, according to the CDC. As this group ages, they are at higher risk for poor nutrition, due to factors like loss of appetite, limited mobility or even inflammation from the disease itself.
Despite its pervasiveness and severe consequences, malnutrition far too often goes undetected or is deprioritized. But the good news is that health care providers and leading nutrition experts have found ways to easily and cost-effectively solve this growing issue in hospitals.
An Appetite for Nutrition Improvements: Advocate Health Care's Quality Improvement Program
How can hospitals and healthcare practitioners more effectively address this issue? It can start by fostering institutional awareness of nutrition's critical influence on the quality of patient care. For clinical practices, experts recommend adopting a systematic, interdisciplinary approach to malnutrition that includes:
• The routine screening and assessment of all patients for malnutrition using a validated tool such as the Malnutrition Screening Tool (MST)
• Prompt initiation of nutrition interventions for patients who are malnourished or at-risk of malnutrition
• Documentation of all malnutrition diagnoses in the electronic medical record (EMR) in order to make diagnostic information easily accessible to physicians, nurses, and other clinicians
• Individualized, in-hospital nutrition care plans
• Continued monitoring of each patient's nutrition status during their stay
• Nutritional education for patients and caregivers throughout the hospital stay and at discharge
A recent multi-site study that incorporated these recommendations clearly shows that this kind of approach can improve health outcomes. This collaborative research between Advocate Health Care and Abbott tested a real-world nutrition care program at four hospitals in Chicagoland.
Nearly half of patients, more than 1,200 adults, admitted to one of the four hospitals were at-risk for malnutrition and participated in the nutrition care programs. Those patients received one of two nutrition care programs (a basic or enhanced) which both included:
• Malnutrition risk screening conducted by nursing staff at admission using MST cued by the EMR system
• A follow-up consultation by a dietitian and nutrition treatment, via an oral nutrition supplement, for malnourished patients or those at-risk of malnutrition
• Those in the enhanced program also received post-discharge nutrition education and follow-up calls to confirm they were continuing their nutrition plans
The study results showed that optimizing nutrition care can improve patient health outcomes as well as health system quality indicators. When compared to previous readmission rates and lengths of stay for malnourished patients at the hospitals, the programs on average reduced patient readmissions by 27 percent and lengths of stay by nearly two days (a 25 percent reduction).
Other hospitals have implemented practices to improve nutrition care and have shown similar results. For example, a recent retrospective study, published in the Journal of Nursing Care Quality, evaluated the quality improvement practices implemented at Cleveland Clinic's Akron General Medical Center. The study found that providing prompt nutrition care, via a malnutrition protocol, resulted in reduced length of stay, readmission and cost of care.
Looking at Nutrition as a Vital Sign
Taking action to improve a patient's nutrition status does not often occur, largely because of patients' immediate acute care needs. Because the focus is on treating the primary condition first, many physicians and other clinicians may not be fully focused on a person's nutritional status and how it could be impacting them from recovering.
One promising idea for improving people's nutritional status comes from DefeatMalnutrition.Today, a coalition of more than 50 healthcare and older adult organizations. It advocates that nutrition should be recognized as a new "vital sign," just like blood pressure or pulse rate, for older adults. As part of their efforts, the coalition and others are recommending that the Centers for Medicare and Medicaid Services adopt a set of malnutrition quality measures into its value-based programs. Doing so will help provide quality, timely and coordinated care starting in the hospital, and also will make sure a patient's nutritional status remains in their health records after being discharged to their home or post-acute care.
Although such changes may take time, hospital executives and healthcare practitioners need to not wait to prioritize nutrition as an integral part of a patient's standard of care. The pioneering nutrition care program at Advocate Health Care provides a real world example of a sustainable, evidence-based model that could be scaled today for broad use by other healthcare systems and hospitals.
Suela Sulo, Ph.D., M.S., is a health outcomes researcher in the department of Health Economics and Outcomes Research at Abbott, the global healthcare company. Suela has more than a decade of experience in researching patient-centered outcomes. At Abbott, she studies the impact of nutrition interventions on patient outcomes and healthcare costs.
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