Economic and operational burden associated with malnutrition in chronic obstructive pulmonary disease

Hoong, Jian Ming; Ferguson, Maree; Hukins, Craig; Collins, Peter

doi:10.1016/j.clnu.2016.07.008

Cited by 46 publications

(38 citation statements)

References 35 publications

(30 reference statements)

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“…These findings are supported by a 1-year, prospective, observational pilot study conducted in 834 outpatients with COPD attending a large tertiary Australian hospital during 2011 (Hoong et al, 2017). The study showed that malnourished patients had a significantly higher 1-year mortality rate than non-malnourished patients (27.7% versus 12.1%; P=0.001) (Hoong et al, 2017). Malnourished patients were also hospitalised more frequently than those who were not malnourished and the length of hospital stay for malnourished patients was almost double that of nonmalnourished patients (11.6 versus 6.7 days; P=0.003) (Hoong et al, 2017).…”

Section: Prevention Is Better Than Curesupporting

confidence: 58%

“…Furthermore, in a budget impact analysis of the effects of implementing the NICE (2006; clinical guidelines and quality standard on nutritional support in adults, treating 85% of patients with malnutrition and COPD was shown to save £119 000-£154 0 00 per 100 000 UK general population (Elia, 2015). These findings are supported by a 1-year, prospective, observational pilot study conducted in 834 outpatients with COPD attending a large tertiary Australian hospital during 2011 (Hoong et al, 2017). The study showed that malnourished patients had a significantly higher 1-year mortality rate than non-malnourished patients (27.7% versus 12.1%; P=0.001) (Hoong et al, 2017).…”

Section: Prevention Is Better Than Curementioning

confidence: 78%

“…Malnourished patients were also hospitalised more frequently than those who were not malnourished and the length of hospital stay for malnourished patients was almost double that of nonmalnourished patients (11.6 versus 6.7 days; P=0.003) (Hoong et al, 2017). Overall, the cost of treating malnourished patients was approximately twice that of treating patients who were not malnourished ($23 652 AUD versus $12 362 AUD; P=0.002) (Hoong et al, 2017).…”

Section: Prevention Is Better Than Curementioning

confidence: 99%

See 2 more Smart Citations

‘Mind the gap’: the importance of managing malnutrition in chronic obstructive pulmonary disease

Shepherd¹,

Bowell

2019

Br J Nurs

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Malnutrition is linked to poor outcomes in patients with chronic obstructive pulmonary disease (COPD), and reduced fat free mass and low BMI are independent risk factors for increased mortality. However, weight loss is not inevitable and can be prevented or reversed so screening for malnutrition is essential. The latest guidelines for managing malnutrition in COPD recommend first-line nutritional support. In particular, patients with a BMI <20 kg/m2 should be prescribed oral nutritional supplements (ONS), which have been shown to significantly improve outcomes. However, this guidance is often not implemented locally, increasing the likelihood of malnutrition, hospital admission and increased healthcare costs. Ready-prepared, low-volume, high-protein, high-energy drinks can improve compliance with ONS, particularly in people who are unable to tolerate high volumes. ONS therefore play an important role in managing malnutrition in COPD, helping to reduce its physiological and economic effects.

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Section: Prevention Is Better Than Curesupporting

confidence: 58%

Section: Prevention Is Better Than Curementioning

confidence: 78%

Section: Prevention Is Better Than Curementioning

confidence: 99%

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‘Mind the gap’: the importance of managing malnutrition in chronic obstructive pulmonary disease

Shepherd¹,

Bowell

2019

Br J Nurs

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“…Based on these findings, 8 TAs with the best-quality evidence were selected for further analysis, as prioritized by points on rubric scores (Table 3). They included cross-disease malnutrition, 7,24-33 sepsis, 27,34-41 surgical complications, [42][43][44][45][46][47][48][49][50] HACs, [51][52][53][54][55][56][57][58] congestive heart failure, 9,[59][60][61][62][63][64][65][66][67][68] COPD, 8,9,16,[69][70][71][72][73] GI cancer, [74][75][76][77][78][79][80][81][82] and pancreatitis. [83][84][85]…”

Section: Task 1 Literature Analysismentioning

confidence: 99%

Value of Nutrition Support Therapy: Impact on Clinical and Economic Outcomes in the United States

Tyler

Barrocas

Guenter

et al. 2020

J Parenter Enteral Nutr

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Objective Healthcare leaders seek guidance on prudent investment in programs that improve patient outcomes and reduce costs, which includes the value of nutrition therapy. The purpose of this project was to conduct an evidence review and evaluate claims analyses to understand the financial and quality impact of nutrition support therapy on high‐priority therapeutic conditions. Methods Task 1 included a review of existing literature from 2013 to 2018 to identify evidence that demonstrated the clinical and economic impact of nutrition intervention on patient outcomes across 13 therapeutic areas (TAs). In Task 2, analytic claims modeling was performed using the Medicare Parts A and B claims 5% sample dataset. Beneficiaries diagnosed in 5 selected TAs (sepsis, gastrointestinal [GI] cancer, hospital‐acquired infections, surgical complications, and pancreatitis) were identified in the studies from Task 1, and their care costs were modeled based on nutrition intervention. Results Beginning with 1099 identified articles, 43 articles met the criteria, with a final 8 articles used for the Medicare claims modeling. As examples of the modeling demonstrated, the use of advanced enteral nutrition formula could save at least $52 million annually in a sepsis population. The total projected annual cost savings from the 5 TAs was $580 million. Conclusion Overall, optimization of nutrition support therapy for specific patient populations is estimated to reduce Medicare spending by millions of dollars per year across key TAs. These findings demonstrate the evidence‐based value proposition of timely nutrition support to improve clinical outcomes and yield substantial cost savings.

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“…The aetiology of malnutrition is complex and multi-factorial which makes its identification in the clinical setting challenging, particularly in older patients, as a result it often goes underdiagnosed and untreated [1]. Malnutrition in inpatients has been found to present both an economic and operational burden with malnourished patients experiencing significantly higher rates of emergency hospitalisation, prolonged durations of hospital stay and increased subsequent healthcare costs [2]. Therefore, identifying individuals at risk of malnutrition or diagnosing malnutrition, allowing the initiation of nutritional support is fundamental to the provision of safe and effective clinical care.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the concurrent validity of body mass index (BMI) in the identification of malnutrition in older hospital inpatients

Collins

Hickling

et al. 2019

Clinical Nutrition

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Background: Nutrition screening and assessment tools often include body mass index (BMI) as a component in identifying malnutrition risk. However, rising obesity levels will impact on the relevancy and applicability of BMI cutoff points which may require re-evaluation. This study aimed to explore the relationship between commonly applied BMI cutoffs and diagnosed malnutrition. Methods: Data (age, gender, BMI and Subjective Global Assessment (SGA) ratings) were analysed for 1152 inpatients aged !65 years across annual malnutrition audits (2011e2015). The receiver operation characteristic (ROC) curve analysed the optimal BMI cutoff for malnutrition and concurrent validity of commonly applied BMI cutoffs in nutritional screening and assessment tools. Results: Malnutrition prevalence was 36.0% (n ¼ 372) using SGA criteria (not malnourished, moderate or severe malnutrition). Median age was 78.7 (IQR 72e85) years, median BMI 25.4 (IQR 21.8e29.7) kg/m 2 ; 52.1% male and 51.2% overweight/obese. ROC analysis identified an optimal BMI cutoff of <26 kg/m 2 , 80.8% sensitivity and 61.5% specificity (AUC 0.802, 95% CI 0.773, 0.830; p < 0.0001). Commonly applied BMI cutoffs (between 18.5 and 23 kg/m 2) failed to meet the alpha-priori requirement of 80% sensitivity and 60% specificity. However, BMI <23 kg/m 2 had the highest agreement (k ¼ 0.458) with malnutrition diagnosed using the SGA. Conclusions: Both malnutrition and overweight/obesity are common in older inpatients. Continuing increases in the prevalence of overweight and obesity will impact on the sensitivity of BMI as a screening component for malnutrition risk. The current study suggests tools developed over a decade ago may need to be revisited in future.

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Economic and operational burden associated with malnutrition in chronic obstructive pulmonary disease

Abstract: Malnutrition is an independent predictor of 1-year mortality and healthcare use in patients with COPD. Malnourished patients with COPD present both an economic and operational burden.

Cited by 46 publications

References 35 publications

‘Mind the gap’: the importance of managing malnutrition in chronic obstructive pulmonary disease

‘Mind the gap’: the importance of managing malnutrition in chronic obstructive pulmonary disease

Value of Nutrition Support Therapy: Impact on Clinical and Economic Outcomes in the United States

Evaluating the concurrent validity of body mass index (BMI) in the identification of malnutrition in older hospital inpatients

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