Differences in Nutrition Interventions Among Malnourished Hospitalized Patients

Abstract

Abstract Objectives This study examined how nutrition intervention approach and utilization rate varied by the method of malnutrition risk documentation. Methods 16,669 hospital patient records collected from 4 US hospital systems from January–June 2019 as part of the Malnutrition Quality Improvement Initiative (MQii) Learning Collaborative were analyzed. Nutrition interventions included: enteral nutrition, parenteral nutrition, ONS, feeding assistance, food and nutrition related medical management, nutrition education, counseling, and care coordination. Results Similar numbers of patients were documented as malnourished by nutrition assessment (n = 1087) and medical diagnosis (n = 1186). Only 46% (n = 692) of patients documented as malnourished by assessment or diagnosis received a nutrition intervention. The most frequently used interventions were ONS (n = 854), nutrition education (n = 318), and care coordination (n = 290). 53.1% of patients who received a nutrition intervention received multiple nutrition interventions; the average number of interventions was 2.03. Patients with a physician diagnosis of malnutrition more frequently received parenteral and enteral nutrition (7.75% vs 1.78%, P = 0.0191, and 26.36% vs 7.69%, P < 0.0001, respectively), while patients with malnutrition documented by a registered dietitian more frequently received ONS (82.84% vs 58.14%, P < 0.0001) and counseling (52.66% vs 1.55%, P < 0.0001). Conclusions Utilization of nutrition interventions for patients documented by nutrition assessment and medical diagnosis are quite similar, suggesting a positive level of care coordination exist. Differences in intervention utilization rate and approach are consistent with previous literature showing that physicians diagnose and treat more severely malnourished patients, often through enteral and parenteral nutrition. Future work is needed to investigate the impact of each intervention type separately and combined on patient health and economic outcomes. Funding Sources The MQii is a project of the Academy of Nutrition and Dietetics, Avalere Health, and hospital stakeholders who participated in the collaborative partnership. Abbott provided financial support for MQii development and application.