Nutrition Care for Poorly Nourished Outpatients Reduces Resource Use and Lowers Costs

Abstract

Background and Objectives: Over 25% of United States (US) community-dwelling, older adults are at nutritional risk. Health and cost burdens of poor nutrition can be lowered by nutrition programs for hospital inpatients, but few studies have looked at the impact on outpatients. The objective of our study was to assess outcomes of a nutrition focused quality improvement program (QIP) on healthcare resource use and costs in poorly nourished outpatients. Methods: This pre-post QIP study was implemented at 3 US healthcare system clinics. Included patients (n = 600) were ≥45 years old, had ≥2 chronic conditions, and were enrolled over a 15-month interval. For comparison, historical (n = 600) and concurrent control (n = 600) groups were used. Assessment of poor nutritional status was performed during each patient’s baseline visit. Healthcare resource use (hospitalizations, emergency department visits, and outpatient clinic visits), medication use, and costs were determined for a 90-day interval. Results: QIP patients (mean age 61.6 years) were predominantly female (62.5%) and overweight/obese (81.7%). The proportion of QIP outpatients presenting for healthcare services was significantly reduced compared to both historical and concurrent controls—relative risk reduction (RRR) versus historical (11.6%, P < .001) and versus concurrent (8.9%, P = .003). Of those who presented, RRR for healthcare resource use by QIP was significant in comparison with historical (12.9%, P = .022) but not concurrent controls. No significant differences were observed for medication usage. Lower resource use among QIP patients yielded total cost savings of $290 923 or per-patient savings of $485. Conclusions: Nutrition QIPs in outpatient clinics are feasible and can reduce healthcare resource use and cut costs. Such findings underscore benefits of nutritional interventions for community-dwelling outpatients with poor nutritional status.

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“…Registered Dietitians (RDs) are specialists in human nutrition 8 and, similar to other allied health professionals (AHPs), work in diverse care settings. Targeted, timely medical nutrition therapy interventions by RDs have been associated with improved patient outcomes and cost reductions in inpatient, 18,20 outpatient/primary healthcare, 22,42,43 long-term care, 44-46 and home care 47 settings. In many cases, factors limiting patients’ access to RD services could be mitigated by the introduction of innovative processes and policies.…”

“…[17][18][19] For example, the benefits of identifying and treating malnutrition in hospitalized patients are well known. 18,[20][21][22] Despite this, malnutrition is definitively underdiagnosed in that population. 18,20,21 Promisingly, innovative, hospital-based, Registered Dietitian (RD)-led quality improvement initiatives have resulted in decreased lengths of stay, 18,20 reduced rates of infection, 18 improved rates of provider-documented malnutrition diagnosis, 20,21 reduced screening form error rates, 19 shorter turnaround time from screening to referral, 19 and increased speed of prescription of oral nutrition supplements for malnourished patients.…”

The Role of Inpatient Malnutrition Care to Address Health Disparities among Older Adults

“…Outpatient settings also benefit from nutrition-focused quality improvement programs, which have shown reductions in resource use and in cost. 32 There is also an opportunity to encourage full utilization of community and federal nutrition support services. For example, fewer than 50% of eligible older adults are enrolled in the Supplemental Nutrition Assistance Programthe nation's largest federal nutrition assistance program-attributed to social isolation and lack of awareness.…”

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“…Malnutritiodiagnózissal nézünk szembe, ha legalább egy fenotípusos és legalább egy etiológiai tényező fennáll, a malnutritio súlyosságát pedig a fenotípusos elemek alapján szükséges megítélni [11]. A klinikai gyakorlatban, azon belül is a fekvőbeteg-ellátásban egyelőre eddig csak a rizikószűrő skálák használata terjedt el, a járóbeteg-ellátásban pedig rizikószűrést sem végeznek rutinszerűen [12].…”