Effect of Hospital Use of Oral Nutritional Supplementation on Length of Stay, Hospital Cost, and 30-Day Readmissions Among Medicare Patients With COPD

Snider, Julia Thornton; Jena, Anupam B.; Linthicum, Mark T.; Hegazi, Refaat; Partridge, Jamie; LaVallee, Chris; Lakdawalla, Darius N.; Wischmeyer, Paul E.

doi:10.1378/chest.14-1368

Cited by 62 publications

(49 citation statements)

References 49 publications

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“…Guest et al (2011) (22), in a retrospective analysis of 1,000 homecare adult patients, observed a significant increase in hospital readmission in malnourished patients (BMI < 18.5 kg/m 2 ), with statistical significance (13% vs 5% [p < 0.05]). In an 11-year retrospective study of information on 44 million adult inpatients, Philipson et al found that, relative to patients who did not receive ONS, those given ONS had a shorter average LoS by 2.3 days (95% CI = -2.42 to -2.16), from 10.9 to 8.6 days (21.0% less), and a $4,734 average decrease in episode cost (95% CI = $-4,754 to $-4,714), from an average cost of $21,950 to $17,216 (21.6% decline) (23).…”

Section: Depletion Of Body Muscle and Fat Tissues Including Intra-mentioning

confidence: 99%

Hospital and Homecare Malnutrition and Nutritional Therapy, in Brazil. Strategies for Alleviating it: A Position Paper

Waitzberg¹,

Aguilar-Nascimento²,

Dias³

et al. 2017

Nutr Hosp

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Section: Depletion Of Body Muscle and Fat Tissues Including Intra-mentioning

confidence: 99%

Hospital and Homecare Malnutrition and Nutritional Therapy, in Brazil. Strategies for Alleviating it: A Position Paper

Waitzberg¹,

Aguilar-Nascimento²,

Dias³

et al. 2017

Nutr Hosp

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“…2,19,20 Nutrition screening and interventions (eg, oral nutritional supplements [ONS]) have proven effective for improving patient outcomes and reducing overall costs of care for patients who are malnourished or at risk for malnutrition. [21][22][23][24][25][26][27][28] For example, several studies of hospitalized patients showed that nutrition screening and assessment, when followed by intervention as needed, could shorten length of stay (LOS) by at least 2 days. 24,28,29 Given their integral role during a patient's hospital stay, nurses are ideally positioned to identify patients at risk for malnutrition and facilitate their treatment.…”

mentioning

confidence: 99%

“…[21][22][23][24][25][26][27][28] For example, several studies of hospitalized patients showed that nutrition screening and assessment, when followed by intervention as needed, could shorten length of stay (LOS) by at least 2 days. 24,28,29 Given their integral role during a patient's hospital stay, nurses are ideally positioned to identify patients at risk for malnutrition and facilitate their treatment. [30][31][32] A nurse-led program was initiated at Akron General Medical Center ([AGMC], Akron, Ohio), a Magnet hospital and level 1 trauma center, and a recent addition to the Cleveland Clinic Health System, to update the hospital nutrition care process and streamline its delivery.…”

mentioning

confidence: 99%

Health System Quality Improvement

Meehan

Loose

Bell

et al. 2016

Journal of Nursing Care Quality

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Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced.

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“…Patients with advanced COPD often have nutritional deficiency and low body mass index; and long LoS in these patients can be significantly reduced by oral nutrition supplementation [21]. In our LoS patients, we found reduced serum albumin and an increased pressure sore risk as shown by reduced Braden score.…”

Section: Discussionmentioning

confidence: 53%

Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study

Madani¹,

Saigal²,

Sunny³

et al. 2017

Turk Thorac J

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OBJECTIVES:Chronic obstructive pulmonary disease (COPD) exacerbation is one of the most common reasons for hospital admission. Patients with COPD with a long length of stay (LoS) occupy a disproportionately high fraction of hospital bed-days. The objective of this study was to identify associations of long LoS in patients admitted with COPD exacerbation. MATERIAL AND METHODS:From December 2012 until June 2013, 499 patients were admitted to Queens Hospital, Romford, UK, with COPD exacerbation. Mean LoS was 7 days, with a median of 5 days, and a 90th percentile of 14 days. In this retrospective observational cohort study, 64 patients with a short LoS were compared with 62 patients with a long LoS. RESULTS:Relative to the short LoS, patients with long LoS had significantly lower arterial blood pH, higher arterial PaCO2 and HCO3, higher white cell count, higher globulin and more frequent chest X-ray changes, lower albumin levels, and lower Barthel and Braden scores. They were less likely to have seen the hospital COPD specialist nurse, more likely to require escalation of social care on discharge, and more likely to die during admission. Nearly 66% of the long LoS patients remained in hospital beyond the time of being medically fit for discharge. Commonly cited reasons for delayed discharge were the wait for therapy and social services assessments and the wait for commencement of community social care. CONCLUSION:Meticulous targeting of features peculiar to long LoS patients has the potential to reduce future hospital bed-days for patients with COPD in our and other hospitals. KEYWORDS:Chronic obstructive pulmonary diseases, length of stay INTRODUCTIONChronic obstructive pulmonary disease (COPD) is a common chronic disease in the UK with a likely prevalence of 3 million people or 4% of the population [1]. Episodic exacerbations are usual and often require hospital admission. COPD exacerbation is the second most common reason for emergency admission to hospital behind circulatory disease and is associated with considerable risks of re-admission, death, and expense. Each COPD hospital admission is estimated to cost NHS commissioners £1960 [2].Estimates of typical length of stay (LoS) vary in the published literature. A British Thoracic Society study found a mean value of 7.1 days, whereas in Norway, it was 8.9 days, and a study in Blackpool reported 9.8 days [3][4][5]. Importantly, there is significant variation across England and Wales between many aspects of service provision and clinical outcomes for patients with respiratory disease. The NHS Atlas of Variation in Healthcare 2010 highlighted a four-fold variation in hospital bed-days occupied by COPD patients [6]. In London, there is a variation in LoS between hospitals by nearly 5 days [7]. Those patients with long LoS also occupy disproportionately more bed-days, and 50% of bed-days have been shown to be occupied by the minority of patients who stay at least 11 days [8]. Previously described associations of long LoS in COPD include poor organization of care, lack...

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Effect of Hospital Use of Oral Nutritional Supplementation on Length of Stay, Hospital Cost, and 30-Day Readmissions Among Medicare Patients With COPD

Cited by 62 publications

References 49 publications

Hospital and Homecare Malnutrition and Nutritional Therapy, in Brazil. Strategies for Alleviating it: A Position Paper

Hospital and Homecare Malnutrition and Nutritional Therapy, in Brazil. Strategies for Alleviating it: A Position Paper

Health System Quality Improvement

Characterization of Chronic Obstructive Pulmonary Disease Patients with a Long Length of Stay: A Retrospective Observational Cohort Study

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