University of Maryland Medical Center, Baltimore, Maryland, USA.
Tulane School of Medicine, New Orleans, Louisiana, USA.
JPEN J Parenter Enteral Nutr. 2020 Mar;44(3):395-406. doi: 10.1002/jpen.1768. Epub 2020 Jan 29.
Healthcare leaders seek guidance on prudent investment in programs that improve patient outcomes and reduce costs, which includes the value of nutrition therapy. The purpose of this project was to conduct an evidence review and evaluate claims analyses to understand the financial and quality impact of nutrition support therapy on high-priority therapeutic conditions.
Task 1 included a review of existing literature from 2013 to 2018 to identify evidence that demonstrated the clinical and economic impact of nutrition intervention on patient outcomes across 13 therapeutic areas (TAs). In Task 2, analytic claims modeling was performed using the Medicare Parts A and B claims 5% sample dataset. Beneficiaries diagnosed in 5 selected TAs (sepsis, gastrointestinal [GI] cancer, hospital-acquired infections, surgical complications, and pancreatitis) were identified in the studies from Task 1, and their care costs were modeled based on nutrition intervention.
Beginning with 1099 identified articles, 43 articles met the criteria, with a final 8 articles used for the Medicare claims modeling. As examples of the modeling demonstrated, the use of advanced enteral nutrition formula could save at least $52 million annually in a sepsis population. The total projected annual cost savings from the 5 TAs was $580 million.
Overall, optimization of nutrition support therapy for specific patient populations is estimated to reduce Medicare spending by millions of dollars per year across key TAs. These findings demonstrate the evidence-based value proposition of timely nutrition support to improve clinical outcomes and yield substantial cost savings.
医疗保健领导者寻求有关审慎投资于改善患者预后和降低成本的项目的指导，其中包括营养治疗的价值。本项目的目的是进行证据审查和评估索赔分析，以了解营养支持治疗对高优先级治疗情况的财务和质量影响。
任务 1 包括对 2013 年至 2018 年现有文献的审查，以确定证明营养干预对 13 个治疗领域（TA）患者预后的临床和经济影响的证据。在任务 2 中，使用医疗保险 A 部分和 B 部分索赔 5%抽样数据集进行分析性索赔建模。在任务 1 中从研究中确定了在 5 个选定 TA（败血症、胃肠道[GI]癌症、医院获得性感染、手术并发症和胰腺炎）中诊断出的受益人的护理费用，根据营养干预对其进行建模。
从 1099 篇已识别的文章开始，有 43 篇文章符合标准，最终有 8 篇文章用于医疗保险索赔建模。作为建模演示的示例，使用先进的肠内营养配方每年至少可以节省 5200 万美元的败血症患者费用。5 个 TA 的总预计年度节省成本为 5.8 亿美元。
总体而言，估计针对特定患者人群优化营养支持治疗每年可减少医疗保险在关键 TA 上的支出数百万美元。这些发现证明了及时进行营养支持以改善临床结果并带来大量成本节约的循证价值主张。
