A three-step nutrition intervention model associated with better health outcomes and reduced costs

Healthcare providers, payers and patients— all of which have a vested interest in creating and ensuring healthy communities, driven by two common considerations: positive health outcomes and reduced cost of care. Stakeholder success across the board is possible when an intervention or treatment improves patient health and reduces the overall cost of care for patients and healthcare systems. However, improving health outcomes while reducing costs, regardless of the setting of care, includes an often overlooked, anda rarely discussed element that has the potential to prohibit success on both fronts: nutrition health.

Understanding and addressing patients' nutrition status is often a key component of reducing the length of hospital stays, decreasing the use of medical resources and lowering the total cost of care.

The Burden of Malnutrition

Whether undernourished or overnourished, the effects of malnutrition can be harmful to achieving good health and is costly for patients and the larger healthcare system alike. In the United States, the cost of disease-associated malnutrition from conditions such as cancer or cardiovascular disease has been estimated at more than $147 billion per year, with $15.5 billion attributed directly to treatment costs.^1,2 Further, people who are hospitalized and found to be malnourished may incur hospital costs nearly twice as high as those who are adequately nourished.³

Comprehensive nutrition care that delivers the nutrients patients need can improve overall health and reduce the use of healthcare resources and costs across hospitals, outpatient clinics, and community care settings.

One Model to Address Malnutrition Across Care Settings Equals Better Outcomes for All

Healthcare providers often only have a few minutes to connect with their patients, which means that many may feel they don’t have enough time to discuss important topics like diet and nutrition. By implementing simple but comprehensive nutrition programs, healthcare providers can screen for malnutrition, assess risk and quickly determine if further intervention is needed. This model includes a three-step approach:

• Screen Patients to Determine Malnutrition Risk: Ask a few simple questions to assess for under- or overnutrition, including: Has food intake changed recently? Has the patient lost weight without trying? Has patient experienced a recent illness or injury? Has patient noticed weight gain within the past 3-6 months?
• Communicate a Personalized Nutrition Care Plan: Create a customized plan for patients at risk for malnutrition and recommend an appropriate nutritional drink such as Ensure or Glucerna to help patients get the nutrients they need.
• Deliver Nutrition Education: Educate patients and caregivers on the importance of nutrition and nutritional drinks compliance.

This model has been successful in acute care settings like hospitals, leading to cost savings of nearly $4,000 per patient, shortened length of hospital stays and reduced readmission rates.^4,5 Another study implementing a similar nutrition program in transitional care touchpoints like home healthcare settings has also shown to have significantly reduced hospitalization rates and healthcare costs by an estimated $1,500 per patient treated.⁶

Nutrition Interventions in Action: Addressing Patients' Nutrition Needs Equally Across Different Healthcare Settings

Although nutrition interventions in hospitals and home healthcare settings have created significant impact on driving better health outcomes and reducing costs, there continues to be an opportunity to better understand what enables people to follow nutrition plans after their initial point of care. A new study from University of Southern California and Abbott published in the Journal of Primary Care and Community Health⁷ conducted at three outpatient primary care clinics shows that nutrition interventions among middle-aged and older adults at malnutrition risk can be extended beyond the healthcare setting to optimize patient care.

The study found that implementing the same three-step nutrition program helped improve care, reduce healthcare resource use by 11.6%^* over 90-days, and lower healthcare costs by almost $500 per patient treated.⁷ This new research shows that, when implemented, this simple nutrition model works, regardless of the setting of care, enabling healthcare practitioners to assess and cost-effectively address malnutrition risk.^4-8

Quality of Care is Everyone's Priority

Stakeholders across the continuum of care benefit when people are properly nourished. The three clinics that participated in the study saw a significant decrease in the percentage of patients using healthcare resources over 90 days, allowing healthcare providers to better manage their patients while reducing costs. The quality of care also improved, with 81.8% of patients reporting high levels of satisfaction with their nutrition care.^7,8

While managing costs is important to leaders in healthcare practices and systems responsible for managing healthcare expenditure, healthcare professionals and administrators are generally more concerned about delivering quality care to their patients and enabling healthy outcomes. When nutrition is considered as a component of the overall treatment plan, patients can also feel better about the holistic regimen of care they are receiving to actively treat symptoms and manage conditions. To bring the value of nutrition to healthcare, healthcare authorities have an opportunity to develop effective practices, policies, and comprehensive malnutrition strategies across the continuum of care – making our communities healthier for all.

About the Author

Suela Sulo, PhD, MS is a health outcomes researcher and currently leads the Health Economics, Outcomes Research, and Policy work for Abbott’s global nutrition research and development. Suela helps design and disseminate numerous research studies and quality improvement programs, which measure the impact of nutrition interventions on process and patient outcomes as well as healthcare costs.

References

_{*11.6% represents the relative reduction in the percentage of patients that utilized healthcare resources in the nutrition program group compared with the historical control group. Healthcare resource use refers to combination of all-cause90-day hospitalizations, emergency department visits, and outpatient clinic visits captured via electronic medical record data abstraction and self-reported patient survey data.}

_{1. Snider JT, Linthicum MT, Wu Y, et al. JPEN J Parenter Enteral Nutr. 2014;38(2):77S–85S. doi:10.1177/014860711455000015.} 

_{2. Goates S, Du K, Braunschweig CA, et al. PLoS One. 2016;11(9):e0161833. doi:10.1371/journal.pone.016183316.}

_{3. Barrett M, Baily M, Owens P. US AHRQ 2018; 2018;1–29. www.hup-us.ahrq.gov/reports.jsp.}

_{4. Sriram K, Sulo S, VanDerBosch G, et al. JPEN J Parenter Enteral Nutr. 2017;41(3):384–391.42} 

_{5. Sulo S, Feldstein J, Partridge J, et al. Am Health Drug Benefits. Jul 2017;10(5):262-270.}

_{6. Riley K, Sulo S, Dabbous F, et al. (2020) JPEN J Parenter Enteral Nutr, 44(1): 58-68.}

_{7. Hong K, Sulo S, Wang W, et al. J Prim Care Community Health. 2021;12:1-11.}

_{8. Hong K, Sulo S, Wang W, et al. ASPEN. 2021 Poster Presentation.}