title: A Comprehensive Nutrition-Focused Quality Improvement Program Reduces 30-Day Readmissions and Length of Stay in Hospitalized Patients.
abstract: Although screening patients for malnutrition risk on hospital admission is standard of care, nutrition shortfalls are undertreated. Nutrition interventions can improve outcomes. We tested effects of a nutrition-focused quality improvement program (QIP) on hospital readmission and length of stay (LOS).
  
  
  
  QIP included malnutrition risk screening at admission, prompt initiation of oral nutrition supplements (ONS) for at-risk patients, and nutrition support. A 2-group, pre-post design of malnourished adults with any diagnosis was conducted at 4 hospitals: QIP-basic (QIPb) and QIP-enhanced (QIPe). Comparator patients had a malnutrition diagnosis and ONS orders. For QIPb, nurses screened all patients on admission using an electronic medical record (EMR)-cued Malnutrition Screening Tool (MST); ONS was provided to patients with MST scores ≥2 within 24-48 hours. QIPe had ONS within 24 hours, postdischarge nutrition instructions, telephone calls, and ONS coupons. Primary outcome was 30-day unplanned readmission. We used baseline (January 1-December 31, 2013) and validation cohorts (October 13, 2013-April 2, 2014) for comparison.
  
  
  
  Patients (n = 1269) were enrolled in QIPb (n = 769) and QIPe (n = 500). Analysis included baseline (n = 4611) and validation (n = 1319) comparator patients. Compared with a 20% baseline readmission rate, post-QIP relative reductions were 19.5% for all QIP, 18% for QIPb, and 22% for QIPe, respectively. Compared with a 22.1% validation readmission rate, relative reductions were 27.1%, 25.8%, and 29.4%, respectively. Similar reductions were noted for LOS.
  
  
  
  Thirty-day readmissions and LOS were significantly lowered for malnourished inpatients by use of an EMR-cued MST, prompt provision of ONS, patient/caregiver education, and sustained nutrition support.
authors.affiliation: 1 Advocate Health Care, Downers Grove, Illinois, USA.
authors.forename: Krishnan
authors.initials: K
authors.lastname: Sriram
authors.affiliation: 1 Advocate Health Care, Downers Grove, Illinois, USA.|2 Abbott Nutrition, Columbus, Ohio, USA.
authors.forename: Suela
authors.initials: S
authors.lastname: Sulo
authors.affiliation: 1 Advocate Health Care, Downers Grove, Illinois, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: VanDerBosch
authors.affiliation: 2 Abbott Nutrition, Columbus, Ohio, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Partridge
authors.affiliation: 3 Center for Applied Value Analysis, Great Barrington, Massachusetts, USA.
authors.forename: Josh
authors.initials: J
authors.lastname: Feldstein
authors.affiliation: 2 Abbott Nutrition, Columbus, Ohio, USA.
authors.forename: Refaat A
authors.initials: RA
authors.lastname: Hegazi
authors.affiliation: 1 Advocate Health Care, Downers Grove, Illinois, USA.
authors.forename: Wm Thomas
authors.initials: WT
authors.lastname: Summerfelt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000628:therapy*; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D015596:Nutrition Assessment; D044623:Nutrition Therapy; D009752:Nutritional Status; D018529:Nutritional Support; D064686:Nutritionists; D010359:Patient Readmission; D058996:Quality Improvement; D012307:Risk Factors; D018401:Sample Size
keywords: nutrition; nutrition assessment; nutrition education; nutrition support practice; nutrition-focused interventions; outcomes research/quality