Current use and clinical outcome of home parenteral and enteral nutrition therapies in the United States.
OBJECTIVE
Home nutrition support, especially when delivered parenterally, is very costly. The aim of this study is to examine current usage of home parenteral and enteral nutrition (HPEN) in the United States and the quality of therapy outcome.


METHODS
Medicare HPEN use from 1989 to 1992 was analyzed to assess use, growth, and costs. National Registry information collected on 9288 patients treated with HPEN from 1985 to 1992 was used to assess disease distribution and therapy outcome.


RESULTS
In the United States, there were approximately 40,000 parenteral and 152,000 enteral home patients in 1992. The usage of HPEN doubled between 1989 and 1992, and a large proportion was in patients with short survival. The prevalence of HPEN in the United States was 4-10 times higher than in other Western countries. Outcome data showed both therapies were relatively safe. The primary disease strongly influenced survival and rehabilitation, and age, per se, was not a reason to deny HPEN.


CONCLUSIONS
Predicted quality survival at home for several months, rather than a specific diagnosis, seems to be the soundest justification for HPEN. Its role in terminal conditions and patients without primary gastrointestinal diseases needs further evaluations.
Howard
L
L
Department of Medicine, Albany Medical College, New York, USA.
Ament
M
M
Fleming
C R
CR
Shike
M
M
Steiger
E
E
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D004750:Enteral Nutrition / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D006278:Medicare; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D012042:Registries; D016896:Treatment Outcome; D014481:United States