Yale New Haven Hospital, New Haven, Connecticut, USA.
Covidien LP, a Medtronic company, Boulder, Colorado, and Mansfield, Massachusetts, USA.
JPEN J Parenter Enteral Nutr. 2018 May;42(4):730-738. doi: 10.1177/0148607117713479. Epub 2017 Dec 22.
Enteral nutrition (EN) supports many older and disabled Americans. This study describes the frequency and cost of acute care hospitalization with dehydration and/or malnutrition of Medicare beneficiaries receiving EN, focusing on those receiving home EN.
Medicare 5% Standard Analytic Files were used to determine Medicare spending for EN supplies and the proportion and cost of beneficiaries receiving EN, specifically home EN, admitted to the hospital with dehydration and/or malnutrition.
In 2013, Medicare paid $370,549,760 to provide EN supplies for 125,440 beneficiaries, 55% of whom were also eligible for Medicaid. Acute care hospitalization with dehydration and/or malnutrition occurred in 43,180 beneficiaries receiving EN. The most common principal diagnoses were septicemia (21%), aspiration pneumonitis (9%), and pneumonia (5%). In beneficiaries receiving EN at home, >one-third (37%) were admitted with dehydration and/or malnutrition during a mean observation interval of 231 ± 187 days. Admitted patients were usually hospitalized more than once with dehydration and/or malnutrition (1.73 ± 1.30 admissions) costing $23,579 ± 24,966 per admitted patient, totaling >$129,685,622 during a mean observation interval of 276 ± 187 days. Mortality in the year following enterostomy tube placement was significantly higher for admitted compared with nonadmitted patients (40% vs 33%; P = .05).
Acute care hospitalizations with dehydration and/or malnutrition in Medicare beneficiaries receiving EN were common and expensive. Additional strategies to reduce these, with particular focus on vulnerable populations such as Medicaid-eligible patients, are needed.
肠内营养（EN）为许多美国老年人和残疾人提供支持。本研究描述了接受 EN 治疗的 Medicare 受益人的脱水和/或营养不良的急性护理住院的频率和费用，重点关注接受家庭 EN 的人群。
使用 Medicare 5%标准分析文件确定 Medicare 为 EN 用品提供的支出，以及接受 EN 治疗的受益人的比例和费用，特别是接受家庭 EN 的受益人的比例和费用，以及因脱水和/或营养不良而住院的受益人的比例和费用。
2013 年，Medicare 为 125,440 名受益人的 EN 用品支付了 370,549,760 美元，其中 55%的人也有资格获得医疗补助。接受 EN 治疗的 43,180 名受益人的急性护理住院与脱水和/或营养不良有关。最常见的主要诊断是败血症（21%）、吸入性肺炎（9%）和肺炎（5%）。在接受家庭 EN 治疗的受益人中，超过三分之一（37%）在平均观察间隔 231±187 天内因脱水和/或营养不良住院。入院患者通常不止一次因脱水和/或营养不良住院（1.73±1.30 次入院），每位入院患者的费用为 23,579±24,966 美元，在平均观察间隔 276±187 天内总计超过 129,685,622 美元。与非入院患者相比，肠造口管放置后一年内的死亡率在入院患者中显著更高（40% vs 33%；P=.05）。
接受 EN 治疗的 Medicare 受益人的脱水和/或营养不良的急性护理住院很常见且费用高昂。需要采取额外的策略来减少这些住院，特别是针对 Medicaid 资格患者等弱势群体。
