Training residents to perform bedside paracentesis procedures was highly cost-effective. This approach should be considered as part of national efforts to reduce hospital costs while providing quality care.
Background: Identification and treatment of malnutrition across the care continuum can help prevent illness onset or relapse and maximize the effectiveness of other medical treatments. This study aimed to evaluate the effect of a nutrition-focused quality improvement program (QIP) conducted in a home health agency (HHA) on hospitalization rates and healthcare costs incurred over 90 days. Methods: This was a multisite, pre-post QIP implemented at 2 branches of an Illinois-based HHA. The QIP included 1546 patients who were (1) at-risk or malnourished hospitalized patients discharged to the HHA, (2) referred by a physician during an outpatient visit, or (3) enrolled in the HHA through a skilled nursing facility. A historic (n = 7413 patients) and concurrent group (n = 5235) of patients were used for comparisons. Propensity score matching was used to account for imbalances in patient characteristics. Results: The QIP led to reduced relative risk of hospitalization post-enrollment to the QIP by 24.3%, 22.8%, and 18.3% at 30, 60, and 90 days, respectively, when compared with the historic group, and by 18.2%, 16.2%, and 12.1% when compared with the concurrent group. Total cost savings from reduced 90-day healthcare resource utilization was $2,318,894, or $1500 per patient treated. Conclusions: Rates of hospitalization and healthcare resources can be significantly reduced through the implementation of a nutrition-focused QIP delivering oral nutritional supplements in home health settings for adults atrisk/malnourished. These results highlight the importance of nutrition as a strategy for HHAs and other post-acute care institutions to improve patients' health outcomes and generate cost savings. (JPEN J Parenter Enteral Nutr. 2020;44:58-68)
Students are more likely than faculty to use SNS and use it very differently than faculty. Students would benefit from training on appropriate use of SNS. Topics that should be addressed include editing one's online presence, managing friend requests from patients, dealing with colleagues who post harmful content, conducting Internet searches on patients, and discussion of boundaries to identify potential harms associated with SNS usage. Differences in usage between students and faculty raise questions if faculty are well suited to provide this training.
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