Widespread transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a global coronavirus disease 2019 (COVID-19) pandemic that is straining medical resources worldwide. In the United States (US), hospitals and clinics are challenged to accommodate surging patient populations and care needs while preventing further infection spread. Under such conditions, meeting with patients via telehealth technology is a practical way to help maintain meaningful contact while mitigating SARS-CoV-2 transmission. The application of telehealth to nutrition care can, in turn, contribute to better outcomes and lower burdens on healthcare resources. To identify trends in telehealth nutrition care before and during the pandemic, we emailed a 20-question, qualitative structured survey to approximately 200 registered dietitian nutritionists (RDNs) from hospitals and clinics that have participated in the Malnutrition Quality Improvement Initiative (MQii). RDN respondents reported increased use of telehealth-based care for nutritionally at-risk patients during the pandemic. They suggested that use of such telehealth nutrition programs supported positive patient outcomes, and some of their sites planned to continue the telehealth-based nutrition visits in post-pandemic care. Nutrition care by telehealth technology has the potential to improve care provided by practicing RDNs, such as by reducing no-show rates and increasing retention as well as improving health outcomes for patients. Therefore, we call on healthcare professionals and legislative leaders to implement policy and funding changes that will support improved access to nutrition care via telehealth.

Changes to the payment structure of the United States (U.S.) healthcare system are leading to an increased acuity level of patients receiving short-term skilled nursing facility care. Most skilled nursing facility patients are older, and many have medical conditions that cannot be changed. However, conditions related to nutrition/muscle mass may be impacted if there is early identification/intervention. To help determine the diagnosis and potential impact of nutrition/muscle mass-related conditions in skilled nursing facilities, this study evaluated 2016–2020 US Medicare claims data. Methods aimed to identify a set of skilled nursing facility claims with one or more specific diagnoses (COVID-19, malnutrition, sarcopenia, frailty, obesity, diabetes, and/or pressure injury) and then to determine length of stay, discharge status, total charges, and total payments for each claim. Mean values per beneficiary were computed and between–group comparisons were performed. Results documented that each year, the total number of Medicare skilled nursing facility claims declined, whereas the percentage of claims for each study diagnosis increased significantly. For most conditions, potentially related to nutrition/muscle mass, Medicare beneficiaries had a shorter length of skilled nursing facility stays compared to those without the condition(s). Furthermore, a lower percentage of these Medicare beneficiaries were discharged home (except for those with claims for sarcopenia and obesity). Total claim charges for those with nutrition/muscle mass-related conditions exceeded those without (except for those with sarcopenia). We conclude that although the acuity level of patients in skilled nursing facilities continues to increase, skilled nursing facility Medicare claims for nutrition/muscle mass-related conditions are reported at lower levels than their likely prevalence. This represents a potential care gap and requires action to help improve patient health outcomes and skilled nursing facility quality metrics.

The Oncology Care Model (OCM) is a US Centers for Medicare & Medicaid Services (CMS) specialty model implemented in 2016, to provide higher quality, more highly coordinated oncology care at the same or lower costs. Under the OCM, oncology clinics enter into payment arrangements that include financial and performance accountability for patients receiving chemotherapy treatment. In addition, OCM clinics commit to providing enhanced services to Medicare beneficiaries, including care coordination, navigation, and following national treatment guidelines. Nutrition is a component of best-practice cancer care, yet it may not be addressed by OCM providers even though up to 80% of patients with cancer develop malnutrition and poor nutrition has a profound impact on cancer treatment and survivorship. Only about half of US ambulatory oncology settings screen for malnutrition, registered dietitian nutritionists (RDNs) are not routinely employed by oncology clinics, and the medical nutrition therapy they provide is often not reimbursed. Thus, adequate nutrition care in US oncology clinics remains a gap area. Some oncology clinics are addressing this gap through implementation of nutrition-focused quality improvement programs (QIPs) but many are not. What is needed is a change of perspective. This paper outlines how and why quality nutrition care is integral to the OCM and can benefit patient health and provider outcomes.

Symptoms of peripheral arterial disease (PAD) are frequently associated with impaired health-related quality-of-life (HRQOL), which, in turn, impacts overall life satisfaction. However, there are few reports of patient expectations related to PAD interventions. The purpose of this analysis was to evaluate treatment-related changes in HRQOL in the ORION study. METHODS: ORION enrolled 125 patients, at 28 US centers, who had been diagnosed with chronic, symptomatic iliac disease. Patients received ≤2 nitinol stents in the common and/or external iliac artery. The Walking Impairment Questionnaire (WIQ), a validated PAD-specific quality-of-life instrument, was completed by each patient to assess his or her walking distance, walking speed, and stairclimbing ability. RESULTS: Significant improvements (p<.0001) in all 3 domain scores of the WIQ were reported at 12 months postintervention. The walking distance mean score increased from 14.56±19.36 at baseline to 55.88±38.02 at 12 months. Walking speed and stair-climbing mean scores increased from 18.38±19.18 and 26.14±26.91, respectively, at baseline to 47.96±31.80 and 57.72±37.17 at 12 months. Prior to intervention, 20.2% of patients were able to walk no more than 50 feet and 21.0% could walk at least 1500 feet. Improvement in maximum walking distance was observed; at 12 months, only 5.5% of patients could walk no more than 50 feet, while 63.3% could walk at least 1500 feet. Postintervention, there was an approximately 5-fold increase in patients who could run/jog one city block at 12 months (34.9%), compared to baseline (7.3%) and an approximately 2-fold increase in those who could climb at least 3 flights of stairs at 12 months (62.4%), compared to baseline (32.3%). CONCLUSIONS: Significant improvements in HRQOL, related to walking and stair climbing ability, were observed after nitinol stent placement. Future studies will target whether pretreatment HRQOL patient education affects patient perception and satisfaction related to the procedure and provider.

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