malnutrition and health care: implications for policy … and health care: implications for policy...
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Jeanne Blankenship, MS RDN Vice President, Policy Initiatives and Advocacy
Malnutrition and Health Care: Implications for Policy Makers
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A Changing Healthcare Landscape
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Clinical Outcomes Increasingly Important
12010 HIDA Acute Care Market Report, Alexandria Va. www.HIDA.org
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Malnutrition is an Independent Predictor of Poor Clinical Outcomes
What is Malnutrition?
What is Malnutrition?
What is Malnutrition?
Prevalence of Malnutrition in Hospitals
• 30-50% of patients are malnourished upon admission
• A 2011 Johns Hopkins study showed that 53% of patients are malnourished
• 38% of patients with normal nutrition status experience decline during hospitalization
1Correia and Campos. Nutrition
2003;19:823-825.
2Somanchi. JPEN 2011;35:209-216.
3Braunschweig et al. JADA 2000;100:136-
1322.
Up to
Diagnoses Associated with Hospital Malnutrition
Lim et al, Clinical Nutrition, 2012
Nutrition Care Process
Assessment
Diagnosis: Nutrition Problem
Intervention
Monitor, Measure & Evaluation
Etiology of Nutrition Problem
Screening
Surgical site Infection 2.5
5.3
5.1
Pressure Ulcer 3.8
Mediastinitis after CABG
Odds Ratio
Catheter-associated UTI
0 1 2 3 4 5 6
Fry et al. Arch Surg. 2010;145:148-151.
Surg site infection 2.5
3.8
5.1
Pressure ulcer 3.8
Malnutrition/Weight Loss
Catheter-associated UTI
Mediastinitis after CABG 5.3
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Risk of Hospital Acquired Events with Pre-Existing Malnutrition/Weight Loss
Demling. Eplasty. 2009;9:65-94.
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Loss of Lean Body Mass Affects Risk for Complications That Can Lead to Never Events
Readmission Risk is Associated with Nutritional Status
• Markers of frailty (poor overall condition, pressure sores, prior hospitalization)1
• Severe disability (inability for self-feeding)1
• Weight loss2
• BMI: higher risk in those underweight and obese
• Cancer3
• Renal failure3
• Congestive heart failure3
1 Laniece .Age Aging 2008;37:416-22. 2 Allaudeen et al. J Hosp Med.
2011;6:54-60. 3 Mudge et al. J Hosp Med. 2011 Feb;6(2):61-67.
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In-hospital Mortality & Nutritional Status
Consequences of Unrecognized Malnutrition
Increased length of stay
Increased morbidity/mortality
Impaired wound healing
Increased admission/readmission rates
Higher infection/complication rates
Costs
Int J Environ Res Public Health 2011;8:514-527.
Slide from Academy of Nutrition and Dietetics 5/23/12 Teleseminar “From Theory to Practice: Optimizing Recognition and Documentation of Adult Malnutrition”
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Increased muscle loss/functional loss
Multidisciplinary initiatives for addressing patient nutrition
Create a Culture Where All
Stakeholders Value Nutrition
Empowerment of All Clinicians
Recognition and Diagnosis of All Malnourished
Patients
Same-Day Automated Nutrition
Intervention and Continued Monitoring
All NCP Fully Outlined,
Documented, and Communicated
Discharge NCP and Tailored Education
Provided
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Adult Malnutrition
(if ≥2 present)
Insufficient energy intake
Weight loss
muscle mass
subcutaneous fat
Fluid accumulation
functional status
White et al., JAND 2012;112:730-738.
White et al., JPEN 2012;36:275-283.
Academy/ASPEN Consensus: Characteristics Recommended
for the Identification and Documentation of Adult Malnutrition
How do we get here?
• Limited coverage for nutrition interventions
• Hospital admission
• Discharge destination
• Some food vs. quality food
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Preventing Nutrition Problems
Safety Net Programs -Child Nutrition Programs (including WIC) -Head Start -Child Care Centers -SNAP/SNAP-Ed -Congregate Dining Programs -Home Delivered Meals Others -Faith-based and Community Programs -Food Banks -Food Trusts
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Conclusion
• Malnutrition is a major health issue effecting a majority of hospitalized patients and costing the health system millions of dollars
• Nutrition has a standardized language and work is being done to establish it in medical frameworks
• EHRs effectively could result in quicker more efficient identification and intervention of malnutrition thus improving care and saving money
