The Association between Oral Nutritional Supplements and 30-Day Hospital Readmissions of Malnourished Patients at a US Academic Medical Center.
30-day hospital readmissions
Health care disparities
Length of hospital stay
Malnutrition
Oral nutritional supplements
Journal
Journal of the Academy of Nutrition and Dietetics
ISSN: 2212-2672
Titre abrégé: J Acad Nutr Diet
Pays: United States
ID NLM: 101573920
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
25
08
2018
revised:
20
12
2018
accepted:
21
01
2019
pubmed:
8
4
2019
medline:
12
6
2020
entrez:
8
4
2019
Statut:
ppublish
Résumé
Malnutrition affects up to 50% of hospitalized patients and contributes to adverse health and economic outcomes, but often remains unrecognized or undertreated. This study assessed the utilization of oral nutritional supplements (ONS) and its association with the number of 30-day unplanned hospital readmissions of adult malnourished patients in comparison with the readmissions rates of their malnourished counterparts who did not receive ONS. This was a retrospective cohort study. Of 153,161 inpatient encounters analyzed, a total of 8,713 (5.7%) malnourished adults admitted to an academic medical center hospital in the United States between October 1, 2016, and September 30, 2017 were included in the analyses. The study utilized records of patients at risk of malnutrition on admission and subsequently diagnosed as malnourished by a registered dietitian following established criteria. ONS utilization rate, hospital length of stay (LOS), and 30-day unplanned hospital readmissions data were obtained from electronic medical records. The associations between the number of 30-day unplanned hospital readmissions and ONS use were analyzed using mixed-effects negative binomial regression models, with coefficients and 95% CIs reported. Important covariates such as age, sex, and the severity of illness index were included in the regression models. Only 3.1% of malnourished patients received ONS. ONS users had 38.8% fewer readmissions compared with non-ONS counterparts (P=0.017). The reduction in hospital readmissions by ONS was even greater for oncology patients (46.1%, P<0.001). A 50% reduction in time from hospital admission to ONS provision was associated with a 10.2% (P<0.01), 10.2% (P=0.014), and 16.6% (P<0.01) decrease in LOS for overall, oncology, and intensive care unit encounters, respectively. In a large cohort of malnourished adult inpatient encounters, ONS provision rate was low, but when used, ONS intervention was associated with 38.8% fewer 30-day readmissions. This association was more pronounced for oncology encounters. Shorter LOS was observed when the interval between admission and ONS initiation was shorter. Reduced LOS and readmissions rates could result in financial benefits for health care systems prioritizing hospital nutrition care, in addition to informing significant medical benefits for their patients.
Sections du résumé
BACKGROUND
Malnutrition affects up to 50% of hospitalized patients and contributes to adverse health and economic outcomes, but often remains unrecognized or undertreated.
OBJECTIVE
This study assessed the utilization of oral nutritional supplements (ONS) and its association with the number of 30-day unplanned hospital readmissions of adult malnourished patients in comparison with the readmissions rates of their malnourished counterparts who did not receive ONS.
DESIGN
This was a retrospective cohort study.
PARTICIPANTS/SETTING
Of 153,161 inpatient encounters analyzed, a total of 8,713 (5.7%) malnourished adults admitted to an academic medical center hospital in the United States between October 1, 2016, and September 30, 2017 were included in the analyses. The study utilized records of patients at risk of malnutrition on admission and subsequently diagnosed as malnourished by a registered dietitian following established criteria.
MAIN OUTCOMES MEASURES
ONS utilization rate, hospital length of stay (LOS), and 30-day unplanned hospital readmissions data were obtained from electronic medical records.
STATISTICAL ANALYSES PERFORMED
The associations between the number of 30-day unplanned hospital readmissions and ONS use were analyzed using mixed-effects negative binomial regression models, with coefficients and 95% CIs reported. Important covariates such as age, sex, and the severity of illness index were included in the regression models.
RESULTS
Only 3.1% of malnourished patients received ONS. ONS users had 38.8% fewer readmissions compared with non-ONS counterparts (P=0.017). The reduction in hospital readmissions by ONS was even greater for oncology patients (46.1%, P<0.001). A 50% reduction in time from hospital admission to ONS provision was associated with a 10.2% (P<0.01), 10.2% (P=0.014), and 16.6% (P<0.01) decrease in LOS for overall, oncology, and intensive care unit encounters, respectively.
CONCLUSIONS
In a large cohort of malnourished adult inpatient encounters, ONS provision rate was low, but when used, ONS intervention was associated with 38.8% fewer 30-day readmissions. This association was more pronounced for oncology encounters. Shorter LOS was observed when the interval between admission and ONS initiation was shorter. Reduced LOS and readmissions rates could result in financial benefits for health care systems prioritizing hospital nutrition care, in addition to informing significant medical benefits for their patients.
Identifiants
pubmed: 30954446
pii: S2212-2672(18)31864-1
doi: 10.1016/j.jand.2019.01.014
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1168-1175Informations de copyright
Copyright © 2019 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.