Nutrition Care for Poorly Nourished Outpatients Reduces Resource Use and Lowers Costs

Abstract

Background and objectives: Over 25% of United States (US) community-dwelling, older adults are at nutritional risk. Health and cost burdens of poor nutrition can be lowered by nutrition programs for hospital inpatients, but few studies have looked at the impact on outpatients. The objective of our study was to assess outcomes of a nutrition focused quality improvement program (QIP) on healthcare resource use and costs in poorly nourished outpatients.

Methods: This pre-post QIP study was implemented at 3 US healthcare system clinics. Included patients (n = 600) were ≥45 years old, had ≥2 chronic conditions, and were enrolled over a 15-month interval. For comparison, historical (n = 600) and concurrent control (n = 600) groups were used. Assessment of poor nutritional status was performed during each patient's baseline visit. Healthcare resource use (hospitalizations, emergency department visits, and outpatient clinic visits), medication use, and costs were determined for a 90-day interval.

Results: QIP patients (mean age 61.6 years) were predominantly female (62.5%) and overweight/obese (81.7%). The proportion of QIP outpatients presenting for healthcare services was significantly reduced compared to both historical and concurrent controls-relative risk reduction (RRR) versus historical (11.6%, P < .001) and versus concurrent (8.9%, P = .003). Of those who presented, RRR for healthcare resource use by QIP was significant in comparison with historical (12.9%, P = .022) but not concurrent controls. No significant differences were observed for medication usage. Lower resource use among QIP patients yielded total cost savings of $290 923 or per-patient savings of $485.

Conclusions: Nutrition QIPs in outpatient clinics are feasible and can reduce healthcare resource use and cut costs. Such findings underscore benefits of nutritional interventions for community-dwelling outpatients with poor nutritional status.

Trial registration: ClinicalTrials.gov NCT03628196.

Keywords: cost-savings; nutrition; oral nutritional supplements; outpatients; patient outcomes.

Figure 1.

Patient flow chart.

Figure 2.

Proportion of QIP patients with healthcare resource utilization (A) and average number of healthcare visits over 90-days (B) when compared to control groups.

Figure 3.

Medication utilization at baseline visit versus 90-days by group. *Number represents relative reduction in medication utilization.

Figure 4.

Nutrition Screening Pathway to identify risk of under- and overnutrition in the community. Abbreviation: MST, Malnutrition Screening Tool.