Nutrition Interventions Deliver Value in Healthcare: Real-World Evidence

Abstract

Value is a key guiding principle in healthcare, yet value is defined in varying ways by different stakeholders. In this paper, we review evidence of the health and financial tolls of malnutrition or poor nutrition, report positive results from recent nutrition-focused quality improvement programs in hospitals, and discuss clinical and policy implications of realizing best-practice nutrition care. Hospitalized patients with malnutrition diagnoses have up to twofold greater hospital costs for care compared to inpatient stays for adequately nourished patients. By contrast, implementation of nutrition care programs for hospitalized adults (nutrition status screening, assessment and diagnosis of malnutrition, oral nutritional supplements provided when indicated) is associated with substantial per-patient, per-episode healthcare savings approaching $4,000. Improved nutrition care has also been associated with fewer complications and faster recovery (shortened lengths of stay, lower readmission rates). Nutrition care thus delivers value, which is evidenced by better patient outcomes at cost savings to healthcare systems. What is the "Value" of Therapeutic Nutrition in Healthcare? Value is a central aim for healthcare, yet value is defined in varying and sometimes conflicting terms by different stakeholders-providers, payers, and patients. 1 In terms of health economics, value is determined by outcomes relative to costs (Figure 1). 2 The numerator of the value equation is outcome, while the denominator is cost. Depending on the stakeholder's viewpoint, high value may be seen as reduced patient morbidity and mortality, cost containment, or profitability. Some aspects of value are important to patients and providers alike, eg, outcomes such as survival, fast recovery, few or no complications during hospitalization, and quality of life, as well as experience or satisfaction. To hospitals and healthcare systems, measurable outcomes that contribute to value include reduced length of stay (LOS) and lower readmission rates. Cost-effective treatments represent value to payers. Levels of patient-perceived satisfaction with care are being increasingly monitored as measures of healthcare quality, thus representing values shared by both patients and provider systems. 3 Like health-care processes in general, nutrition care in hospitals and other healthcare settings is beneficial when it improves outcomes. The value of nutrition care is demonstrated when improved health outcomes for hospitalized patients are achieved at reasonable incremental costs for nutrition care and with reduced overall costs of care. Health economic studies support the concept that nutrition care can improve patient outcomes Correspondence: Suela Sulo Abbott Nutrition,