Reducing Hospitalizations and Costs: A Home Health Nutrition‐Focused Quality Improvement Program

Abstract

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)

Community-Dwelling Adults at Nutrition Risk: Characteristics in Relation to the Consumption of Oral Nutritional Supplements

“…Such initiatives included nutrition screening, patient education, ONS supplementation, and follow up mechanisms to promote patient compliance with recommended nutrition regimens. [26][27][28][29] Although malnutrition is commonly associated with undernutrition, it is important to note that the average BMI of our study population was 29.3 kg/m 2 , thus confirming that many community-dwelling adults at nutrition risk are either overweight or obese. Overnutrition is a major public health priority in the United States since more than 1 in 3 adults is overweight or obese.…”

Efficacy and Efficiency of Nutritional Support Teams

“…An NST is often involved in defining the indications for and implementing artificial nutrition [73]. Through the involvement of an NST, there are significantly more correct indications for parenteral nutrition, and, as a result, many labor-intensive interventions can be avoided [53].…”

The Importance of Improving the Quality of Care Among HIV/AIDS Hospitalizations in Portugal

“…In this context, one possible solution to overcome this associated economic burden is to increase value in healthcare by integrating quality measures of hospitals' performance while reducing the costs of healthcare. Previous reviews supported the evidence that there is great potential for decreasing costs by targeting deficiencies in quality, and accordingly we can maximize the benefits given the available resources (19–24). Two important quality measures had obtained growing attention as a benchmark indicator for measuring hospital's performance, thirty-day readmission rate, and length of stay (LOS) (22, 25–28).…”