Changes in nutrition support services between 1984 and 1986.

Reports of the economic impact of diagnosis-related group funding on staffing and patient care in hospitals have varied from optimistic to bleak. The Dietitians in Nutrition Support Practice Group of The American Dietetic Association developed a questionnaire to evaluate changes in nutrition support services provided to inpatients and home patients between 1984 and 1986. The written survey instrument was mailed to clinical nutrition managers at a nationwide random selection of 1,000 hospital members of the American Hospital Association. Two hundred thirty-six responses were received. Respondents reported an increase in the use of enteral nutrition support for inpatients between 1984 and 1986. In 1986, tertiary-care hospitals also reported greater use of parenteral nutrition support and tube feeding for inpatients and home patients than did primary-care hospitals. Tertiary-care hospitals also reported higher staffing in 1986 than did primary-care hospitals in the following areas: clinical, nutrition support, and outpatient dietitians and dietetic technicians. Greater use of enteral and parenteral support for inpatients was noted by large hospitals as well as greater staffing in the following areas: clinical managers; nutrition support, clinical, outpatient, and home care dietitians; and dietetic technicians. However, the ratio of patients to RDs was greater in large than in small hospitals. There was no significant difference in patients:RD ratio between tertiary-care and primary-care hospitals. The only difference between responses from for-profit and nonprofit hospitals was in the number of nutrition support RD positions, which was larger in the nonprofit hospitals. Utilization of nutrition support for inpatients or home patients was not different for hospitals in different profit categories.