Malnutrition is a highly prevalent issue among hospital patients but is not always on healthcare leaders' radars. About 30 percent to 50 percent of patients are malnourished upon admission, according to a 2016 study published in Journal of Parenteral and Enteral Nutrition. Additional studies also link malnutrition to various adverse patient outcomes, including prolonged hospitalizations, higher readmission rates and higher risk of complications or death.
Malnutrition is also very costly for the U.S. healthcare system. The nation spends an estimated $157 billion in direct and indirect malnutrition costs every year, with the Medicare patient population accounting for about $51.3 billion, according to Suela Sulo, PhD, director of global health economics and outcomes research and policy at Abbott.
During a Nov. 10 virtual workshop hosted by Becker's Hospital Review and sponsored by Abbott Nutrition, Dr. Sulo joined Kurt Hong, MD, PhD, executive director of the Center for Clinical Nutrition at Los Angeles-based Keck School of Medicine of USC, to discuss how hospitals can improve nutrition care processes to reduce healthcare utilization and the cost of care.
Four takeaways:
1. Nutrition intervention is an important, but often overlooked priority for many healthcare organizations. Dr. Sulo pointed to a 2013 study published in the American Journal of Managed Care, which found only 1.6 percent of the 44 million patients included in the analysis had received an oral nutritional supplement over an 11-year period. Patients who received oral nutritional supplements during their hospital stay had a 21 percent decrease in length of stay and 6.7 percent decrease in the risk of 30-day readmission. The study also showed nutrition interventions offered an easy way to reduce care costs. "For every dollar spent on oral nutritional supplementation for a hospitalized patient, there was a [return on investment] of $52.63," Dr. Sulo said.
2. A nutrition-focused quality improvement program must entail early and widespread screening, rapid implementation of interventions and continued monitoring for patients, among other key principles. Advocate Aurora Health, which has dual headquarters in Milwaukee and Downers Grove, Ill., partnered with Abbott to roll out a nutrition quality improvement program at four hospitals in 2014. The two hospitals that applied these interventions — which also included providing nutrition education upon discharge and follow-up phone calls with patients — saw a 29.4 percent drop in readmission rates and a 26.4 percent decrease in length of stay.
3. Continuing nutritional supplements after a hospital stay may offer additional benefits for patients and healthcare organizations. Advocate Aurora expanded its quality improvement efforts with a home health nutrition program in which nurses screen patients for malnutrition risk when they arrive home, regardless of their nutrition status in the hospital. Home health patients who participated in the program saw a 22.3 percent drop in 90-day hospitalizations.
"When [we]continue supplementation ... after [patients] go home with home health care services after a recent hospitalization, skilled nursing facility discharge or clinic visit, we are in the position to keep them from being hospitalized for a much longer time," Dr. Sulo said.
4. Healthcare organizations should also consider community-based nutrition interventions for patients visiting outpatient locations to fully address nutrition across the care continuum. USC collaborated with Abbott to adopt a nutrition quality improvement program at three primary care clinics in 2018, according to Dr. Hong. The effort entailed early screening, intervention, education and follow-up protocols for about 600 patients ages 45 and older who had at least two chronic conditions. Patients in the nutrition intervention group demonstrated a 12.9 percent drop in healthcare visits, along with decreased medication use compared to a control group. Overall, the nutrition program led to an estimated cost savings of $290,923 over a 15-month period, which equates to a net savings of $485 per patient, according to Dr. Hong.
"If we had designed this study to follow patients for up to six months or a year, we anticipate this number probably would probably go up," he said. "We also found 81.8 percent of patients were very happy we provided them with opportunities to use oral nutrition supplements as part of their care."
To access the workshop on-demand, click here.