Fiscal and clinical evaluation of home parenteral nutrition.

The clinical management activities performed by nonphysician members of a home parenteral nutrition (HPN) service were evaluated, and the costs of providing a home-care service with a hospital-based supply were projected. The nutrition support service team included two pharmacists, one nurse, one dietitian, one social worker, and two physicians. The clinical activities of the nonphysician members of the service were documented for a one-year period involving 13 patients. Inventory data for items dispensed were obtained from the commercial vender supplying the patients during the study. Projected charges for the hospital pharmacy to deliver supplies were based on actual contract costs to the hospital. An arbitrarily assigned markup of 40% was used to calculate break-even data. The clinical management of the HPN patients required 203 hours of the nonphysician health-care professionals' time. For the initial fiscal year, the fixed and variable costs were projected as $253,360, which amounted to $89.82 per calendar day of home therapy. The hospital would have to provide 1416 calendar days of home parenteral nutrition before revenues equaled expenses at $168,504. The projected annual savings for a patient receiving parenteral nutrition at home rather than in the hospital was $651,651. Supply alternatives for HPN should be evaluated according to specific institutional needs.