title: Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among Medicare patients with COPD.
abstract: BACKGROUND
  COPD is a leading cause of death and disability in the United States. Patients with COPD are at a high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplementation (ONS) has been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown.
  
  
  METHODS
  Using the Premier Research Database, we first identified Medicare patients aged ≥ 65 years hospitalized with a primary diagnosis of COPD. We then identified hospitalizations in which ONS was provided, and used propensity-score matching to compare LOS, hospitalization cost, and 30-day readmission rates in a one-to-one matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also used instrumental variables analysis to study the association of ONS with study outcomes. Model covariates included patient and provider characteristics and a time trend.
  
  
  RESULTS
  Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N = 14,326). In unadjusted comparisons in the matched sample, ONS use was associated with longer LOS (8.7 days vs 6.9 days, P < .0001), higher hospitalization cost ($14,223 vs $9,340, P < .0001), and lower readmission rates (24.8% vs 26.6%, P = .0116). However, in instrumental variables analysis, ONS use was associated with a 1.9-day (21.5%) decrease in LOS, from 8.8 to 6.9 days (P < .01); a hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (P < .01); and a 13.1% decrease in probability of 30-day readmission, from 0.34 to 0.29 (P < .01).
  
  
  CONCLUSIONS
  ONS may be associated with reduced LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD.
authors.affiliation: Precision Health Economics, Los Angeles, CA.
authors.forename: Julia Thornton
authors.initials: JT
authors.lastname: Snider
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA; University of Colorado School of Medicine, Aurora, CO. Electronic address: jena@hcp.med.harvard.edu.
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Jena
authors.affiliation: Precision Health Economics, Los Angeles, CA.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Linthicum
authors.affiliation: Abbott Nutrition, Columbus, OH.
authors.forename: Refaat A
authors.initials: RA
authors.lastname: Hegazi
authors.affiliation: Abbott Nutrition, Columbus, OH.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Partridge
authors.affiliation: Precision Health Economics, Los Angeles, CA.
authors.forename: Chris
authors.initials: C
authors.lastname: LaVallee
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.
authors.forename: Darius N
authors.initials: DN
authors.lastname: Lakdawalla
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wischmeyer
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D019587:Dietary Supplements; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006753:Hospital Records / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009752:Nutritional Status; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012306:Risk; D014481:United States