Prioritizing nutrition care for home patients may curb hospitalization and slash healthcare costs, study finds

25 Jun 2019 --- Prioritizing nutrition care for home health patients at risk for malnutrition has a dramatic impact on helping keep them out of the hospital and saves millions of dollars in healthcare costs, annually. This is according to new research from Advocate Health Care, an Illinois-based care organization, and Abbott, a healthcare company, published in the Journal of Parenteral and Enteral Nutrition. According to the researchers, more research is warranted to cover a wider patient demographic. Moreover, they note that improved patient education on the importance of nutrition for recovery can contribute to fewer hospitalizations.

Nearly five million Americans annually rely on home healthcare to recover from an illness, injury or hospitalization, the study notes. While healthcare providers are constantly striving to improve patients’ health and minimize hospitalizations, nutrition is often not top-of-mind, yet it plays a critical role in helping adults recover and resume their normal lives.

“Research has repeatedly shown that nutrition care programs improve health outcomes of hospitalized patients. This is the first study to step out of the hospital setting and demonstrate that the benefits of prioritizing nutrition care extend to adults receiving home healthcare services,” Suela Sulo, Ph.D., Health Outcomes Researcher at Abbott and study author tells NutritionInsight. 

The researchers followed more than 1,500 home health patients for a duration of 90 days. The study found that when patients at risk for malnutrition received a comprehensive nutrition care program, including nutrition drinks, to aid in their recovery:

• Risk of being hospitalized was significantly reduced by 24 percent in the first 30 days, nearly 23 percent after 60 days, and 18 percent after 90 days.
• Healthcare costs were reduced by more than US$2.3 million or about US$1,500 per patient at risk for malnutrition treated over the course of 90 days.

“Our goal as a home healthcare provider is to help patients get back on their feet as quickly as possible and to keep them out of the hospital,” says Katie Riley, R.N., Vice President, Post Acute Chief Nursing Officer for Advocate Aurora Health and the study’s lead author. 

“While the primary reason people come to home health isn’t because they’re malnourished or at risk, we have found that when we do pay attention to their nutrition care, it helps promote their strength and prevents them from going back to the hospital, which ultimately reduces healthcare costs,” she notes. 

Highlighting the importance of personalization in patient nutrition, Sulo says that when it comes to addressing malnutrition, one size doesn’t fit all. Every patient has unique nutritional needs that should be addressed to promote recovery. The nutrition care program implemented in this study allowed clinicians to tailor the treatment approach based on patient needs. They assessed factors such as the patient’s malnutrition risk, disease state and allergies to provide comprehensive and personalized nutrition care which ultimately helped patients stay out of the hospital and reduced healthcare costs.

According to a Lancet study, personalized nutrition can boost hospital patients’ consumption of protein and calories, as well as improve clinical treatment outcomes. The study showed that individual meal plans resulted in fewer complications and a decreased mortality rate, suggesting that assessments by trained dieticians during patient-admission may tackle the issue.

How policy and patient education can tackle the issue
Approximately one in three home health patients are at risk of malnutrition, which can impact their recovery or cause further health issues, the researchers say. But malnutrition often goes unrecognized as it can be invisible to the eye and can occur in both underweight and overweight individuals. Therefore, more healthcare systems are starting to focus efforts on the identification and management of malnourished or at-risk patients through regular monitoring and follow up.

“It’s clear that nutrition can be a simple, cost-effective tool to improve patient outcomes,” says Sulo. “Healthcare systems are driven to improve patient care while reducing costs. Our research shows that prioritizing nutrition across different settings of care – or from hospital to home – can significantly cut costs while improving patients' health.”

While home health often helps jumpstart the road to recovery, it’s even more effective when patients are given the necessary nutrition education and tools to take their health into their own hands, even after they stop receiving visits from clinicians.

“Educating people about the benefits of proper nutritional care can empower them to continue thinking about their nutrition and drinking their supplements,” notes Gretchen Vanderbosch, study author and Registered Dietitian at Advocate Health Care. “By maintaining proper nutrition, patients have greater strength, heal faster, have fewer falls and reduced readmissions.”

Nutrition care programs – like the one utilized in the study – are sustainable, scalable and reproducible, Sulo says. Any health system or home health agency, whether in a rural community or a large city, can adopt them and see positive outcomes. “We’ve seen the most benefits when programs prioritize identifying patients at risk for malnutrition and provide comprehensive nutrition care including oral nutritional supplements, education and follow-up.”

These programs also require a multidisciplinary approach with different healthcare providers and administrators working together towards a common goal – improving patient outcomes and experience as well as reducing healthcare costs, Sulo explains. 

“Implementing a nutrition program like this is cost-effective and the savings far outweigh the cost of the program. Return on investment for the program in this study was nearly US$6. For each dollar spent, the health system could save approximately US$6,” she adds.

Going forward, Sulo underscores that more research is warranted, as this was a study looking at the impact of nutrition in adults receiving home healthcare. Looking at different patient populations and/or settings of care such as surgery patients, oncology patients or outpatients could help provide additional insights to help scale the nutrition care model and integrate it into other settings of care, like the outpatient setting.

More research on patient malnutrition
Malnutrition among patients is an increasing concern and research is supporting that it is one of the major areas to target to reduce hospitalization time and costs. According to the largest analysis of malnutrition in the US to date, one in three hospitalized adults is at risk of malnutrition, and inadequate food intake is jeopardizing patient recovery and well-being. https://www.nutritioninsight.com/news/one-in-three-us-hospitalized-patients-at-risk-of-malnutrition-study-discovers.html

Moreover, data from Advocate Health Care and Abbott show that implementing a nutrition care program for malnourished surgical patients can achieve a reduction in readmission rates of nearly 50 percent. The findings point to the need for guidelines on improving nutrition before and after surgery for better patient outcomes.

By Kristiana Lalou