Hospital Inpatient Admissions With Dehydration and/or Malnutrition in Medicare Beneficiaries Receiving Enteral Nutrition: A Cohort Study

Abstract

Background: Enteral nutrition (EN) supports many older and disabled Americans. This study describes the frequency and cost of acute care hospitalization with dehydration and/or malnutrition of Medicare beneficiaries receiving EN, focusing on those receiving home EN. Methods: Medicare 5% Standard Analytic Files were used to determine Medicare spending for EN supplies and the proportion and cost of beneficiaries receiving EN, specifically home EN, admitted to the hospital with dehydration and/or malnutrition. Results: In 2013, Medicare paid $370,549,760 to provide EN supplies for 125,440 beneficiaries, 55% of whom were also eligible for Medicaid. Acute care hospitalization with dehydration and/or malnutrition occurred in 43,180 beneficiaries receiving EN. The most common principal diagnoses were septicemia (21%), aspiration pneumonitis (9%), and pneumonia (5%). In beneficiaries receiving EN at home, >one-third (37%) were admitted with dehydration and/or malnutrition during a mean observation interval of 231 ± 187 days. Admitted patients were usually hospitalized more than once with dehydration and/or malnutrition (1.73 ± 1.30 admissions) costing $23,579 ± 24,966 per admitted patient, totaling >$129,685,622 during a mean observation interval of 276 ± 187 days. Mortality in the year following enterostomy tube placement was significantly higher for admitted compared with nonadmitted patients (40% vs 33%; P = .05). Conclusion: Acute care hospitalizations with dehydration and/or malnutrition in Medicare beneficiaries receiving EN were common and expensive. Additional strategies to reduce these, with particular focus on vulnerable populations such as Medicaid-eligible patients, are needed. (JPEN J Parenter Enteral Nutr. 2018;42:730-738)

The experiences and support needs of people living at home with an enteral tube: a qualitative interview study

“…Lack of support to manage ET feeding in the community has been reported to lead to complications, such as tube blockage, increased hospital admissions and dissatisfaction with care provided . Acute care hospitalisations have been reported to be common in some groups receiving enteral nutrition , with many visits to the emergency department being described as potentially avoidable . Avoiding hospital attendance is important because the cost of hospital care is high and it has the potential to negatively impact on the person with an ET .…”

Malnutrition definitions in clinical practice: To be E43 or not to be?

“…The reader is referred to the open access consensus statements for each age group in the Journal of the Academy of Nutrition and Dietetics for further detail. Since 2012, several studies have verified the ability of these malnutrition clinical characteristics to predict patient outcomes (known as predictive validity) (Drake et al, 2018; Hiller et al, 2017; Hudson et al, 2018; Mogensen et al, 2018; Vest et al, 2018). Therefore, clinicians and researchers are encouraged to use the malnutrition clinical characteristics described in these documents to ensure diagnostic consistency between clinicians and facilities.…”

Impact of nutritional and educational support on home enteral nutrition

“…For patients receiving HEN, it is important to remember the importance of ensuring adequate nutrient intake, as malnutrition is associated with increased morbidity and risk of complications in a wide range of patients. This includes patients with chronic obstructive disease, post-stroke patients or bedridden patients at increased risk of pressure ulcers [ 7 , 8 ], and surgical patients (pre- and post-operative) [ 9 ], but especially multimorbid and chronic patients where the incidence of the population with swallowing difficulty primarily due to neurodegenerative problems is very high [ 10 ]. The selection of the most appropriate formula for each patient has been shown to achieve both energy and nutrient therapeutic goals [ 11 ] and improve nutritional status.…”

“…In terms of patient monitoring and follow-up, the coordination of a multidisciplinary team is essential to prevent complications such as malnutrition and dehydration in these patients [ 8 ], as well as complications caused by the EN itself, such as vomiting, diarrhea, constipation, abdominal distension, and complications arising from the access route (nasogastric tube [NGT], percutaneous endoscopic gastrostomy [PEG] and percutaneous radiological gastrostomy [PRG]), such as obstruction [ 15 ].…”