Economic Burden of Disease-Associated Malnutrition at the State Level

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Burden of Underweight in Israel

Ginsberg

Saday

2018

“…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%

“…2 The financial costs of DRM in the United States have been estimated as >$147 billion per year, 7,8 with an excess of $15 billion attributed to direct medical costs for selected conditions associated with malnutrition. 9 The presence of DRM condition represents an opportunity for nutrition care improvements that can yield cost savings in terms of reducing hospital LOS, [10][11][12][13][14] addressing advanced care needs for hospitalized and postdischarge patients, treatments related to complications, 15,16 posthospitalization rehabilitation needs, 4,11,17 and lowering hospital readmissions. 12,18,19 The value of nutrition in healthcare remains poorly understood by clinicians, administrators, and payers.…”

Section: Introductionmentioning

confidence: 99%

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

Tyler

Barrocas

Guenter

et al. 2020

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.

“…In such circumstances, about half of the estimated nutrition requirements are delivered to these patients, [10][11][12][13][14][15][16] subjecting them to the risk of acute malnutrition and complications. [17][18][19][20][21] Severe GDF is a common feature of critical illness and thought to be related to intestinal ischemia-reperfusion injury, particularly during hypotension when vasopressors are used. In addition to the above clinical features, these patients are at risk of nonocclusive mesenteric ischemia, intestinal infarction, perforation, and peritonitis with an 8-fold increase in mortality.…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal Dysfunction in Critical Illness: A Review of Scoring Tools

Asrani

Brown

Huang

et al. 2019

Gastrointestinal dysfunction/failure (GDF) is a common feature of critical illness. There is no consensus on the best way to measure severity of GDF. The aim of this systematic review was to evaluate and compare all gastrointestinal dysfunction scoring tools (GDSTs) to determine aspects that might be useful to construct a new gut scoring tool for intensive care patients. A comprehensive database search of MEDLINE and EMBASE on GDSTs in acute, surgical, and critically ill patients was conducted. Extraction of data was conducted for study characteristics, GDST domains, feasibility of the scoring process, clinical outcomes, and quality of life attributes; independent authors conducted the search, applied the selection criteria, and extracted the data. Methodological quality of studies was assessed. A GDST matrix was created using 14 scoring tools and was evaluated for validity. The 14 GDSTs identified were used in different clinical settings, including critical illness, acute intestinal failure, gastrointestinal disorders, and postoperative patients. There was marked variation between these GDSTs. There is a lack of emphasis in the use of objective laboratory parameters and gut‐specific biomarkers to measure GDF in majority of the studies. The overall quality of evidence was poor, and most tools lacked formal validation. This review has highlighted the lack of an agreed and validated approach to scoring GDF in critical illness. The identified aspects of GDF relevant to critical illness should now be incorporated in a new scoring tool and prospectively tested in intensive care patients.