Thursday, 9 August 2018

Health System Quality Improvement: Impact of Prompt Nutrition Care on Patient Outcomes and Health Care Costs

AMONG HOSPITALIZED PATIENTS, disease-associated malnutrition is a common and widespread problem. Alarmingly, malnutrition or its risk occurs in as many as 50% of patients admitted to hospitals in the United States and around the world. Yet, malnutrition is often overlooked and undertreated in hospital settings. In fact, some patients experience worsening of their nutritional status while hospitalized—resulting from common hospital routines (traditional preparation for surgery, missed mealtimes for medical procedures, and NPO (nil per os) orders, insufficient hospital staffing or education about nutrition care, and patients' disease-related barriers to food intake (disease-related anorexia, too tired to eat, or feeding difficulties). Older adults are particularly vulnerable to undernutrition or specific nutrient deficiencies because they often have diseases and disabilities that limit dietary intake.

Malnutrition has negative impacts on patients and the health care system, leading to more complications, slowed recovery, and higher costs of care. Study results show that malnourished hospital patients, compared with their adequately nourished peers, are more likely to experience pressure ulcers, post surgical infections, falls and are at greater risk for death. These adverse outcomes contribute to the excessive financial burden on our health care system in the form of costly complications, longer hospital stays, and more frequent readmission. Nutrition screening and interventions (e.g., oral nutritional supplements [ONS]) have proven effective for improving patient outcomes and reducing overall costs of care for patients who are malnourished or at risk for malnutrition. For example, several studies of hospitalized patients showed that nutrition screening and assessment, when followed by intervention as needed, could shorten length of stay (LOS) by at least 2 days.

Hospital records of nearly 20 000 patients were evaluated retrospectively. The age range was from 18 to 111 years, with an overall mean age of 59 years, and there were slightly more women than men

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