Sulo Suela, Feldstein Josh, Partridge Jamie, Schwander Bjoern, Sriram Krishnan, Summerfelt Wm Thomas
Senior Manager, Health Economics Outcomes Research, Abbott Nutrition, Chicago, IL.
President and Chief Executive Officer, Center for Applied Value Analysis, Northampton, MA.
Am Health Drug Benefits. 2017 Jul;10(5):262-270.
Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay.
To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention.
The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively.
As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the validation cohort. When these costs were assessed across the entire patient population enrolled in the quality improvement program, per-patient net savings of $1499 when using the baseline cohort as the comparator and savings per patient treated of $3858 when using the validated cohort as the comparator were achieved.
The nutrition-focused quality improvement program reduced the per-patient healthcare costs by avoiding 30-day readmissions and through reduced length of hospital stay. These clinical and economic outcomes provide a rationale for merging patient care and financial modeling to advance the delivery of value-based medicine in a malnourished hospitalized population. The use of a novel web-based budget impact model supports the integration of comparative effectiveness analytics and healthcare resource management in the hospital setting to provide optimal quality of care at a reduced overall cost.
营养干预可通过改善患者预后减轻营养不良负担；然而，关于医学营养干预经济影响的证据仍然有限。一项先前发表的针对营养不良住院患者的以营养为重点的质量改进项目表明，在入院时使用经过验证的筛查工具对患者进行筛查、迅速给予口服营养补充剂并就补充剂依从性对患者进行教育，可显著降低30天内非计划再入院率和住院时间。
通过使用基于网络的预算影响模型的以营养为重点的质量改进项目，评估营养不良住院患者30天再入院率降低和住院时间缩短所带来的潜在成本节约，并证明该干预措施的临床和财务价值。
将参与质量改进项目（2014年10月13日至2015年4月2日）的1269例患者的再入院率和住院时间的降低情况与质量改进项目前的基线队列和验证队列（分别为4611例患者和1319例患者）进行比较，以计算潜在成本节约并为预算影响模型的设计提供依据。再入院率和住院时间的降低分别通过确定从基线到质量改进项目后的变化以及验证队列与质量改进项目后队列之间的差异来计算。
由于治疗患者的健康状况得到改善，以营养为重点的质量改进项目导致30天内医院再入院率和住院时间降低。质量改进项目中的患者避免了医院再入院且住院天数减少，与质量改进项目前的基线队列相比节省了1,902,933美元，与质量改进项目前的验证队列相比节省了4,896,758美元。当在参与质量改进项目的整个患者群体中评估这些成本时，以基线队列为对照时每位患者净节省1499美元，以验证队列为对照时每位接受治疗的患者节省3858美元。
以营养为重点的质量改进项目通过避免30天再入院和缩短住院时间降低了每位患者的医疗保健成本。这些临床和经济结果为将患者护理与财务建模相结合以推进营养不良住院人群中基于价值的医疗服务提供了依据。使用新型基于网络的预算影响模型支持在医院环境中整合比较有效性分析和医疗资源管理，以在降低总体成本的情况下提供最佳护理质量。
