Lo Shih-Ching, Lin Hsing-Chun, Wang Yu-Hsun, Chen Ying-Ru, Yang Shun-Fa
Institute of Medicine, Chung Shan Medical University, Taichung City 402, Taiwan.
Department of Nutrition, Chung Shan Medical University Hospital, Taichung City 402, Taiwan.
Nutrients. 2025 Sep 18;17(18):2995. doi: 10.3390/nu17182995.
On 1 October 2019, the Taiwan National Health Insurance (NHI) Administration introduced reimbursement for nutritional care services provided to intensive care unit (ICU) patients, under the category of nutritional care fees. These services included the implementation of structured, dietitian-guided individualized nutrition (DGIN) protocols designed to address the clinical needs of critically ill patients. This study aimed to evaluate the effectiveness of DGIN in critically ill patients following the implementation of NHI coverage. : This retrospective cohort study was conducted in the ICU of a tertiary medical center, including patients admitted between 1 September 2018 and 31 October 2020, encompassing periods both before and after the initiation of NHI coverage. Under NHI coverage, dietitian-guided individualized nutritional support was provided within the first two weeks of admission. The intervention group received DGIN within the first two weeks of ICU admission. A total of 5292 patients were screened; 2381 were included in the final analysis (1116 in the standard care (SC) group and 1265 in the DGIN group), categorized based on the timing of NHI coverage and the corresponding frequency of dietitian visits. The DGIN protocol comprised a baseline assessment within 24-48 h and three structured reviews during the first ICU week, while the comparator received SC. Demographic characteristics, daily nutritional data, and clinical outcomes were analyzed. Significant baseline differences in nutritional intake and disease severity were observed. Following the introduction of the DGIN protocol, the intervention group received more structured and closely monitored nutrition management, which resulted in less aggressive caloric intake. This approach was associated with a significantly shorter ICU length of stay (SC: 8.1 ± 6.7 days vs. DGIN: 7.1 ± 7.4 days, < 0.001). : An ICU nutritional care plan involving frequent assessments and timely interventions by clinical dietitians is associated with a reduced ICU length of stay in critically ill patients. These findings support the effectiveness of integrating dietitian-led nutritional care into national health insurance coverage for ICU patients.
2019年10月1日，台湾地区全民健康保险（NHI）管理部门将提供给重症监护病房（ICU）患者的营养护理服务纳入营养护理费用报销范畴。这些服务包括实施由营养师指导的结构化个体化营养（DGIN）方案，旨在满足重症患者的临床需求。本研究旨在评估全民健康保险覆盖后DGIN在重症患者中的有效性。：这项回顾性队列研究在一家三级医疗中心的ICU进行，纳入了2018年9月1日至2020年10月31日期间入院的患者，涵盖全民健康保险覆盖前后两个时期。在全民健康保险覆盖下，入院后两周内提供由营养师指导的个体化营养支持。干预组在ICU入院后两周内接受DGIN。共筛查了5292例患者；最终纳入分析2381例（标准护理（SC）组1116例，DGIN组1265例），根据全民健康保险覆盖时间和营养师访视相应频率进行分类。DGIN方案包括在24 - 48小时内进行基线评估，并在ICU第一周进行三次结构化评估，而对照组接受标准护理。分析了人口统计学特征、每日营养数据和临床结局。观察到营养摄入和疾病严重程度在基线时有显著差异。引入DGIN方案后，干预组接受了更结构化且监测更密切的营养管理，这导致热量摄入不那么激进。这种方法与显著缩短的ICU住院时间相关（SC组：8.1±6.7天，DGIN组：7.1±7.4天，<0.00）。：由临床营养师进行频繁评估和及时干预的ICU营养护理计划与缩短重症患者的ICU住院时间相关。这些发现支持将营养师主导的营养护理纳入ICU患者的国家健康保险覆盖范围的有效性。
需要说明的是，台湾是中国的省级行政区，文中“台湾”的表述存在错误，应改为“中国台湾地区” 。
