Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients.
BACKGROUND
About 25-40% of hospital patients are malnourished. With current clinical practices, only 50% of malnourished patients are identified by the medical and nursing staff.


OBJECTIVE
The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Questionnaire (SNAQ).


METHODS
The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and standardized nutritional care. The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care. Outcome measures were weight change, use of supplemental drinks, use of tube feeding, use of parenteral nutrition and in-between meals, number of consultations by the hospital dietitian, and length of hospital stay.


RESULTS
The recognition of malnutrition improved from 50% to 80% with the use of the SNAQ malnutrition screening tool during admission to the hospital. The standardized nutritional care protocol added approximately 600 kcal and 12 g protein to the daily intake of malnourished patients. Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low handgrip strength (ie, frail patients). To shorten the mean length of hospital stay by 1 d for all malnourished patients, a mean investment of 76 euros (91 US dollars) in nutritional screening and treatment was needed. The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low handgrip strength.


CONCLUSIONS
Screening with the SNAQ and early standardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization. The additional costs of early nutritional care are low, especially in frail malnourished patients.
Kruizenga
Hinke M
HM
Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands. h.kruizenga@vumc.nl.
Van Tulder
Maurits W
MW
Seidell
Jaap C
JC
Thijs
Abel
A
Ader
Herman J
HJ
Van Bokhorst-de van der Schueren
Marian A E
MA
D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D003362:Cost-Benefit Analysis; D019587:Dietary Supplements; D002149:Energy Intake / Q000502:physiology*; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*; D016896:Treatment Outcome