Prospective, randomized, controlled, single-blind trial of the costs and consequences of systematic nutrition team follow-up over 12 mo after percutaneous endoscopic gastrostomy.
OBJECTIVE
We assessed the economic and clinical implications of systematic long-term nutrition team follow-up of patients after percutaneous endoscopic gastrostomy.


METHODS
We designed a prospective, randomized, controlled, single-blind trial in a large district hospital and its catchment area. All adult patients referred for a gastrostomy were eligible and randomized into two groups. The intervention group had regular follow-up by the nutrition team (weekly in hospital, monthly after discharge) with appropriate support and advice for patient, carer, and primary care professionals. The control group had no specific nutrition team input (as is often current practice). Endpoints to the study were 12 mo, elective removal of tube, or death. The primary outcome was total health care costs. Secondary outcomes were complications, length of stay, readmissions, nutritional status, and quality of life.


RESULTS
One hundred twelve patients were recruited. Eleven died before the start of the trial, leaving 47 in the intervention group and 54 in the control group. They were well matched for age, sex, and underlying diagnosis. Overall, the health care costs were 13,330 sterlings per patient in the intervention group compared with 16,858 pound sterlings in the control group (two-tailed, P = 0.27), a saving of 21% per patient. The intervention group had shorter lengths of stay, fewer and briefer readmissions, earlier removal of gastrostomy (where appropriate), shorter duration of feeding, and less demand for general practitioners and district nurse inputs. Nutritional status and quality of life were similar.


CONCLUSIONS
Regular systematic nutrition team follow-up for gastrostomy-fed patients does not increase costs and may improve quality of care.
Scott
Fiona
F
Department of Gastroenterology, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, UK.
Beech
Roger
R
Smedley
Fiona
F
Timmis
Lynne
L
Stokes
Elizabeth
E
Jones
Peter
P
Roffe
Christine
C
Bowling
Timothy E
TE
D000368:Aged; D003266:Continuity of Patient Care / Q000191:economics / Q000706:statistics & numerical data; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy / Q000191:economics* / Q000534:rehabilitation; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D009752:Nutritional Status; D010348:Patient Care Team / Q000191:economics; D010359:Patient Readmission; D011446:Prospective Studies; D011787:Quality of Health Care; D011788:Quality of Life; D016037:Single-Blind Method