RESUMEN
Vulnerable adult populations' access to cost-effective medical nutrition therapy (MNT) for improving outcomes in chronic disease is poor or unquantifiable in most Health Resources & Services Association (HRSA)-funded health centers. Nearly 50% of the patients served at Federally Qualified Health Centers are enrolled in Medicaid; the lack of benefits and coverage for MNT is a barrier to care. Because the delivery of MNT provided by registered dietitian nutritionists is largely uncompensated, health centers are less likely to offer these evidence-based services and strengthen team-based care. The expected outcomes of MNT for adults with diabetes, obesity, hypertension, and other conditions align with the intent of several clinical quality measures of the Uniform Data System and quality improvement goals of multiple stakeholders. HRSA should designate MNT as an expanded service in primary care, require reporting of MNT and registered dietitian nutritionists in utilization and staffing data, and evaluate outcomes. Modification to the Centers for Medicare & Medicaid Services Prospective Payment System rules are needed to put patients over paperwork: HRSA health centers should be compensated for MNT provided on the same day as other qualifying visits. Facilitating the routine delivery of care by qualified providers will require coordinated action by multiple stakeholders. State Medicaid programs, Medicaid Managed Care Organizations, and other payers should expand benefits and coverage of MNT for chronic conditions, factor the cost of providing MNT into adequate and predictable payment streams and payment models, and consider these actions as part of an overall strategy for achieving value-based care.
Asunto(s)
Enfermedad Crónica/economía , Enfermedad Crónica/terapia , Centros Comunitarios de Salud/economía , Financiación Gubernamental , Terapia Nutricional/economía , Adulto , Femenino , Administración de los Servicios de Salud , Humanos , Masculino , Estados Unidos , United States Health Resources and Services AdministrationRESUMEN
BACKGROUND: The management of diabetes costs in excess of $1.3 trillion per annum worldwide. Diet is central to the management of type 2 diabetes. It is not known whether dietetic intervention is cost effective. This scoping review aimed to map the existing literature concerning the cost effectiveness of medical nutrition therapy provided by dietitians for people with type 2 diabetes. METHODS: Thirteen scientific databases, including MEDLINE, EMBASE and CINAHL, as well as multiple official websites, were searched to source peer-reviewed articles, reports, guidelines, dissertations and other grey literature published from 2008 to present. Eligible articles had to have assessed and reported the cost effectiveness of dietetic intervention for adults with type 2 diabetes in developed countries. Experimental, quasi-experimental, observational and qualitative studies were considered. RESULTS: Of 2387 abstracts assessed for eligibility, four studies combining 22 765 adults with type 2 diabetes were included. Dietetic intervention was shown to be cost-effective in terms of diabetes-related healthcare costs and hospital charges, at the same time as also reducing the risk of cumulative days at work lost to less than half and the risk of disability 'sick' days at work to less than one-seventh. CONCLUSIONS: The findings highlight the importance of advocacy for medical nutrition therapy for people with type 2 diabetes, with respect to alleviating the great global economic burden from this condition. Further studies are warranted to elucidate the factors that mediate and moderate cost effectiveness and to allow for the generalisation of the findings.
Asunto(s)
Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/dietoterapia , Dietética/economía , Terapia Nutricional/economía , Adulto , HumanosRESUMEN
As nutrition-related diseases contribute to rising health care costs, food retail settings are providing a unique opportunity for registered dietitian nutritionists (RDNs) to address the nutritional needs of consumers. Food as Medicine interventions play a role in preventing and/or managing many chronic conditions that drive health care costs. The objective of this scoping review was to identify and characterize literature examining Food as Medicine interventions within food retail settings and across consumer demographics. An electronic literature search of 8 databases identified 11,404 relevant articles. Results from the searches were screened against inclusion criteria, and intervention effectiveness was assessed for the following outcomes: improvement in health outcomes and cost-effectiveness. One-hundred and eighty-six papers and 25 systematic reviews met inclusion criteria. Five categories surfaced as single interventions: prescription programs, incentive programs, medically tailored nutrition, path-to-purchase marketing, and personalized nutrition education. Multiple combinations of intervention categories, reporting of health outcomes (nutritional quality of shopping purchases, eating habits, biometric measures), and cost-effectiveness (store sales, health care dollar savings) also emerged. The intervention categories that produced both improved health outcomes and cost-effectiveness included a combination of incentive programs, personalized nutrition education, and path-to-purchase marketing. Food as Medicine interventions in the food retail setting can aid consumers in navigating health through diet and nutrition by encompassing the following strategic focus areas: promotion of health and well-being, managing chronic disease, and improving food security. Food retailers should consider the target population and desired focus areas and should engage registered dietitian nutritionists when developing Food as Medicine interventions.
Asunto(s)
Enfermedad Crónica/terapia , Comercio , Dietética/estadística & datos numéricos , Industria de Alimentos , Terapia Nutricional/métodos , Enfermedad Crónica/economía , Enfermedad Crónica/prevención & control , Comportamiento del Consumidor/economía , Análisis Costo-Beneficio , Dietética/economía , Dietética/métodos , Costos de la Atención en Salud , Humanos , Terapia Nutricional/economía , Evaluación de Programas y Proyectos de SaludRESUMEN
INTRODUCTION: Chronic diseases and aging are placing an ever increasing burden on healthcare services worldwide. Nutritional counselling is a priority for primary care because it has shown substantial cost savings. This review aims to evaluate the evidence of the cost-effectiveness of nutritional care in primary care provided by health professionals. A literature search was conducted using PubMed/MEDLINE between January 2000 and February 2019. The review included thirty-six randomized controlled trials (RCTs) and systematic reviews conducted in healthy people and people with obesity, type-2 diabetes mellitus, cardiovascular risk or malnutrition. All the RCTs and reviews showed that nutritional intervention led by dietitians-nutritionists in people with obesity or cardiovascular risk factors was cost-effective. Dietary interventions led by nurses were cost-effective in people who needed to lose weight but not in people at high cardiovascular risk. Some dietary changes led by a primary care team in people with diabetes were cost-effective. Incorporating dietitians-nutritionists into primary care settings, or increasing their presence, would give people access to the healthcare professionals who are best qualified to carry out nutritional treatment, and may be the most cost-effective intervention in terms of health expenditure. Notwithstanding the limitations described, this review suggests that incorporating dietitians-nutritionists into primary health care as part of the multidisciplinary team could be regarded as an investment in health. Even so, more research is required to confirm the conclusions.
INTRODUCCIÓN: Las enfermedades crónicas y el envejecimiento suponen una carga cada vez mayor para los servicios de salud en todo el mundo. El asesoramiento nutricional es una prioridad para la atención primaria porque ha demostrado ahorros sustanciales de costes. Esta revisión tiene como objetivo evaluar la evidencia de la relación coste-efectividad de la atención nutricional en la atención primaria proporcionada por profesionales de la salud. se realizó una búsqueda bibliográfica utilizando PubMed/MEDLINE entre enero de 2000 y febrero de 2019. La revisión incluyó 36 ensayos controlados aleatorios (ECA) y revisiones sistemáticas realizadas en personas sanas y personas con obesidad, diabetes mellitus de tipo 2, riesgo cardiovascular o desnutrición. Todos los ECA y las revisiones mostraron que la intervención nutricional dirigida por dietistas-nutricionistas en personas con obesidad o factores de riesgo cardiovascular fue coste-efectiva. Las intervenciones dietéticas dirigidas por enfermeras fueron coste-efectivas en personas que necesitaban perder peso pero no en personas con alto riesgo cardiovascular. Algunos de los cambios en la dieta dirigidos por un equipo de atención primaria en personas con diabetes también fueron coste-efectivos. La incorporación de dietistas-nutricionistas en entornos de atención primaria, o aumentar su presencia, daría a las personas acceso a los profesionales de la salud mejor calificados para llevar a cabo el tratamiento nutricional, y resultaría más rentable en términos de gasto en salud. A pesar de las limitaciones descritas, esta revisión sugiere que incorporar dietistas-nutricionistas en atención primaria como parte del equipo multidisciplinario podría considerarse una inversión en salud. Aun así, se requiere más investigación para confirmar las conclusiones.
Asunto(s)
Análisis Costo-Beneficio , Dietética/economía , Terapia Nutricional/economía , Grupo de Atención al Paciente/economía , Atención Primaria de Salud/economía , Diabetes Mellitus Tipo 2/dietoterapia , Humanos , Desnutrición/dietoterapia , Obesidad/dietoterapiaRESUMEN
Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence-practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre-post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition model of care in patients with HNC is feasible and can improve outcomes. Benefits of this model of care may be transferrable to other patient groups within cancer settings.
Asunto(s)
Práctica Clínica Basada en la Evidencia/métodos , Neoplasias de Cabeza y Cuello/terapia , Desnutrición/terapia , Terapia Nutricional/métodos , Atención Dirigida al Paciente/métodos , Anciano , Auditoría Clínica , Análisis Costo-Beneficio , Dietética/economía , Dietética/métodos , Dietética/normas , Práctica Clínica Basada en la Evidencia/economía , Práctica Clínica Basada en la Evidencia/normas , Estudios de Factibilidad , Femenino , Grupos Focales , Adhesión a Directriz , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/economía , Implementación de Plan de Salud , Humanos , Masculino , Desnutrición/economía , Desnutrición/etiología , Persona de Mediana Edad , Evaluación Nutricional , Terapia Nutricional/economía , Terapia Nutricional/normas , Evaluación de Procesos y Resultados en Atención de Salud , Grupo de Atención al Paciente/economía , Grupo de Atención al Paciente/normas , Atención Dirigida al Paciente/economía , Atención Dirigida al Paciente/normas , Proyectos Piloto , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
BACKGROUND & AIMS: Between 30 and 50% of Colombian patients are malnourished or at-risk of malnutrition on hospital admission. Malnutrition is associated with poor outcomes and increased costs. We used cost modeling to estimate savings that could be derived from implementation of a nutrition therapy program for patients at malnutrition risk. METHODS: The budget impact analysis was performed using previously-published outcomes data. Outcomes included length of stay, 30-day readmissions, and infectious/non-infectious complications. We developed a Markov model that compared patients who were assigned to receive early nutrition therapy (started within 24-48 h of hospital admission) with those assigned to receive standard nutrition therapy (not started early). Our model used a 60-day time-horizon and estimated event probabilities based on published data. RESULTS: Average total costs over 60 days were $3770 US dollars for patients with delayed nutrition therapy vs $2419 for patients with early nutrition therapy-a savings of $1351 (35.8% decrease) per nutrition-treated patient. Cost differences between the groups were: $2703 vs $1600 for hospital-associated costs; $883 vs $665 for readmissions; and $176 vs $94 for complications. Taken broadly, the potential costs savings from a nutrition care program for an estimated 638,318 hospitalized Colombian patients at malnutrition risk is $862.6 million per year. CONCLUSIONS: Our budget impact analysis demonstrated the potential for hospital-based nutrition care programs to improve health outcomes and reduce healthcare costs for hospitalized patients in Colombia. These findings provide a rationale for implementing comprehensive nutrition care in Colombian hospitals.
Asunto(s)
Hospitalización/estadística & datos numéricos , Desnutrición/prevención & control , Desnutrición/terapia , Terapia Nutricional/métodos , Colombia , Ahorro de Costo , Análisis Costo-Beneficio , Costos de la Atención en Salud , Costos de Hospital/estadística & datos numéricos , Hospitalización/economía , Humanos , Tiempo de Internación , Desnutrición/economía , Terapia Nutricional/economía , Estado Nutricional , Readmisión del Paciente/economía , Readmisión del Paciente/estadística & datos numéricos , QuinolinasRESUMEN
BACKGROUND AND AIMS: The efficacy of nutritional intervention to enhance short- and long-term outcomes of pulmonary rehabilitation in COPD is still unclear, hence this paper aims to investigate the clinical outcome and cost-effectiveness of a 12-month nutritional intervention strategy in muscle-wasted COPD patients. METHODS: Prior to a 4-month pulmonary rehabilitation programme, 81 muscle-wasted COPD patients (51% males, aged 62.5 ± 0.9 years) with moderate airflow obstruction (FEV1 55.1 ± 2.2% predicted) and impaired exercise capacity (Wmax 63.5 ± 2.4% predicted) were randomized to 3 portions of nutritional supplementation per day (enriched with leucine, vitamin D and polyunsaturated fatty acids) [NUTRITION] or PLACEBO (phase 1). In the unblinded 8-month maintenance phase (phase 2), both groups received structured feedback on their physical activity level assessed by accelerometry. NUTRITION additionally received 1 portion of supplemental nutrition per day and motivational interviewing-based nutritional counselling. A 3-month follow-up (phase 3) was included. RESULTS: After 12 months, physical capacity measured by quadriceps muscle strength and cycle endurance time were not different, but physical activity was higher in NUTRITION than in PLACEBO (Δ1030 steps/day, p = 0.025). Plasma levels of the enriched nutrients (p < 0.001) were higher in NUTRITION than PLACEBO. Trends towards weight gain in NUTRITION and weight loss in PLACEBO led to a significant between-group difference after 12 months (Δ1.54 kg, p = 0.041). The HADS anxiety and depression scores improved in NUTRITION only (Δ-1.92 points, p = 0.037). Generic quality of life (EQ-5D) was decreased in PLACEBO but not in NUTRITION (between-group difference after 15 months 0.072 points, p = 0.009). Overall motivation towards exercising and healthy eating was high and did not change significantly after 12 months; only amotivation towards healthy eating yielded a significant between-group difference (Δ1.022 points, p = 0.015). The cost per quality-adjusted life-year after 15 months was EUR 16,750. CONCLUSIONS: Nutritional intervention in muscle-wasted patients with moderate COPD does not enhance long-term outcome of exercise training on physical capacity but ameliorates plasma levels of the supplemented nutrients, total body weight, physical activity and generic health status, at an acceptable increase of costs for patients with high disease burden.
Asunto(s)
Análisis Costo-Beneficio/métodos , Terapia Nutricional/economía , Terapia Nutricional/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Análisis Costo-Beneficio/economía , Análisis Costo-Beneficio/estadística & datos numéricos , Consejo/métodos , Suplementos Dietéticos , Ácidos Grasos Insaturados/uso terapéutico , Femenino , Humanos , Leucina/uso terapéutico , Masculino , Persona de Mediana Edad , Entrevista Motivacional/métodos , Atrofia Muscular/complicaciones , Países Bajos , Evaluación de Programas y Proyectos de Salud/economía , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Resultado del Tratamiento , Vitamina D/uso terapéuticoRESUMEN
INTRODUCTION: The efficient management of health services requires obtaining the highest level of health possible with the available resources. The health economy has developed in recent years under the pressure of a more demanding population, older and with more comorbidities, in an environment of limited resources and greater financing difficulties. The Economics of Nutrition was born as a new discipline that addresses aspects related to the role of economics and nutrition in the health of healthy and sick populations. The economic analyzes are part of the evaluation tools for health interventions. Cost-effectiveness studies are the most frequently used. Cost-effectiveness studies have shown that the use of oral nutritional supplements offer clinical advantages for undernourished patients (reduction of morbidity and mortality) and economic benefits for the system (reduction of hospital stay, lower re-entry rates and cost savings). Oral nutritional supplementation in the integral recovery of the patient with malnutrition related to the disease is cost effective.
INTRODUCCIÓN: La gestión eficiente de los servicios sanitarios obliga a obtener el máximo nivel de salud posible con los recursos disponibles. La economía de la salud se ha desarrollado en los últimos años ante la presión de una población más demandante, de más edad y con más comorbilidades en un entorno de recursos limitados y mayores dificultades de financiación. La economía de la nutrición nace como una nueva disciplina que atiende aspectos relacionados con el papel de la economía y la nutrición en la salud de las poblaciones sanas y enfermas. Los análisis económicos forman parte de las herramientas de evaluación de las intervenciones sanitarias. Los estudios de coste-efectividad "los más frecuentemente utilizados" han demostrado que la utilización de los suplementos nutricional orales ofrece ventajas clínicas para los pacientes desnutridos (reducción de morbimortalidad) y económicas para el sistema (reducción de estancia hospitalaria, menores tasas de reingresos y ahorros de costes). La suplementación nutricional oral en la recuperación integral del paciente con desnutrición relacionada con la enfermedad es coste-efectiva.
Asunto(s)
Desnutrición/economía , Desnutrición/terapia , Neoplasia Residual/terapia , Terapia Nutricional/economía , Adulto , Anciano , Anciano de 80 o más Años , Ahorro de Costo , Análisis Costo-Beneficio , Suplementos Dietéticos , Humanos , Desnutrición/complicaciones , Persona de Mediana Edad , Apoyo NutricionalRESUMEN
BACKGROUND: The term medical nutrition (MN) refers to nutritional products used under medical supervision to manage disease- or condition-related dietary needs. Standardized MN definitions, aligned with regulatory definitions, are needed to facilitate outcomes research and economic evaluation of interventions with MN. OBJECTIVES: Ascertain how MN terms are defined, relevant regulations are applied, and to what extent MN is valued. METHODS: ISPOR's Nutrition Economics Special Interest Group conducted a scoping review of scientific literature on European and US MN terminology and regulations, published between January 2000 and August 2015, and pertinent professional and regulatory Web sites. Data were extracted, reviewed, and reconciled using two-person teams in a two-step process. The literature search was updated before manuscript completion. RESULTS: Of the initial 1687 literature abstracts and 222 Web sites identified, 459 records were included in the analysis, of which 308 used MN terms and 100 provided definitions. More than 13 primary disease groups as per International Classification of Disease, Revision 10 categories were included. The most frequently mentioned and defined terms were enteral nutrition and malnutrition. Less than 5% of the records referenced any MN regulation. The health economic impact of MN was rarely and insufficiently (n = 19 [4.1%]) assessed, although an increase in economic analyses was observed. CONCLUSIONS: MN terminology is not consistently defined, relevant European and US regulations are rarely cited, and economic evaluations are infrequently conducted. We recommend adopting consensus MN terms and definitions, for example, the European Society for Clinical Nutrition and Metabolism consensus guideline 2017, as a foundation for developing reliable and standardized medical nutrition economic methodologies.
Asunto(s)
Suplementos Dietéticos/clasificación , Regulación Gubernamental , Política de Salud/legislación & jurisprudencia , Desnutrición/clasificación , Desnutrición/terapia , Terapia Nutricional/clasificación , Terminología como Asunto , Anciano , Consenso , Suplementos Dietéticos/economía , Nutrición Enteral/clasificación , Europa (Continente)/epidemiología , Femenino , Costos de la Atención en Salud , Política de Salud/economía , Humanos , Masculino , Desnutrición/economía , Desnutrición/epidemiología , Persona de Mediana Edad , Terapia Nutricional/economía , Nutrición Parenteral/clasificación , Formulación de Políticas , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To determine recent insurance claim rates for, facility income from, and the roles of professionals associated with management of nutrition, oral ingestion and oral health maintenance in long-term care insurance facilities (LTCIFs) in Niigata Prefecture. METHODS: A questionnaire on current staffing, oral health professional (OHP) utilisation, and claims for insured benefits for the investigated services was mailed to all LTCIFs in Niigata Prefecture, Japan (n = 304). Claim rates for and average facility income from these benefits were calculated. Facility income was compared between facilities with and without employed OHPs. Statistically significant factors associated with claims for investigated benefits were identified by logistic regression. RESULTS: Responses from 111 facilities indicated that they made insurance claims for nutrition management (95%), transition from tube feeding to oral ingestion (9%), basic maintenance of oral ingestion (39%), additional services for maintenance of oral ingestion (23%), oral health management system (68%), and oral health management (17%). Most facilities established collaborations with private dental clinics, but only 16% of facilities employed OHPs. Facility income was significantly higher (P = 0.005) for facilities that employed OHPs. OHP employment by facilities was associated with claims for four of the six benefits (P < 0.05). CONCLUSIONS: Most facilities consulted with private dental clinics, and 16% of the facilities employed dentists or dental hygienists to help residents manage oral ingestion problems and oral health maintenance. The facility income associated with management of these problems was significantly higher in facilities employing dental professionals.
Asunto(s)
Atención Odontológica/economía , Cuidados a Largo Plazo/economía , Casas de Salud/economía , Terapia Nutricional/economía , Personal de Salud/estadística & datos numéricos , Fuerza Laboral en Salud , Humanos , Revisión de Utilización de Seguros , Seguro de Cuidados a Largo Plazo , Japón , Salud Bucal/economía , Encuestas y CuestionariosRESUMEN
The word "value" encompasses different concepts but it is probably the importance we give to something and its usefulness that best brings us conceptually closer to its meaning. In this text we analyze the reasons why it is necessary to value the usefulness of nutritional therapy. The development of a new discipline, Nutrition Economics, should help us to create value in Clinical Nutrition by incorporating economic evaluation into their research. It also reviews the importance of economic analysis in decision-making and in more detail the very useful tools also used in the field of nutrition economics, such as cost-of-disease studies, cost-effectiveness studies and budget impact. We analyze different works that have allowed us to advance in these fields in recent years. Finally, the difficulties related to the financing of nutrition in the centers as well as the regulation of enteral nutrition in the home are analyzed. The creation of value in clinical nutrition is a task for everyone (healthcare professionals, patients, managers and the pharmaceutical industry).
La palabra "valor" engloba distintos conceptos, pero probablemente sea la importancia que damos a algo y su utilidad lo que mejor nos acerca conceptualmente a su significado. En este texto se analizan las razones por las que se hace necesario poner en valor la utilidad de la terapia nutricional. El desarrollo de una nueva disciplina, la nutrieconomía, debe ayudarnos a crear valor en nutrición clínica mediante la incorporación de la evaluación económica en su investigación. También se revisan la importancia del análisis económico en la toma de decisiones y, con más detalle, las herramientas de gran utilidad también empleadas en el campo de la economía de la nutrición, como son los estudios de coste de la enfermedad, los de coste-efectividad y los de impacto presupuestario. Se analizan distintos trabajos que nos han permitido avanzar en estos campos en los últimos años. Por último, se analizan las dificultades relacionadas con la financiación de la nutrición en los centros así como la regulación de la nutrición enteral en el ámbito domiciliario. La creación de valor en nutrición clínica es una tarea de todos (profesionales sanitarios, pacientes, gestores e industria farmacéutica).
Asunto(s)
Terapia Nutricional , Costo de Enfermedad , Análisis Costo-Beneficio , Nutrición Enteral , Financiación de la Atención de la Salud , Servicios de Atención de Salud a Domicilio , Humanos , Terapia Nutricional/economía , Valor NutritivoRESUMEN
La palabra "valor" engloba distintos conceptos, pero probablemente sea la importancia que damos a algo y su utilidad lo que mejor nos acerca conceptualmente a su significado. En este texto se analizan las razones por las que se hace necesario poner en valor la utilidad de la terapia nutricional. El desarrollo de una nueva disciplina, la nutrieconomía, debe ayudarnos a crear valor en nutrición clínica mediante la incorporación de la evaluación económica en su investigación. También se revisan la importancia del análisis económico en la toma de decisiones y, con más detalle, las herramientas de gran utilidad también empleadas en el campo de la economía de la nutrición, como son los estudios de coste de la enfermedad, los de coste-efectividad y los de impacto presupuestario. Se analizan distintos trabajos que nos han permitido avanzar en estos campos en los últimos años. Por último, se analizan las dificultades relacionadas con la financiación de la nutrición en los centros así como la regulación de la nutrición enteral en el ámbito domiciliario. La creación de valor en nutrición clínica es una tarea de todos (profesionales sanitarios, pacientes, gestores e industria farmacéutica)
The word "value" encompasses different concepts but it is probably the importance we give to something and its usefulness that best brings us conceptually closer to its meaning. In this text we analyze the reasons why it is necessary to value the usefulness of nutritional therapy. The development of a new discipline, Nutrition Economics, should help us to create value in Clinical Nutrition by incorporating economic evaluation into their research. It also reviews the importance of economic analysis in decision-making and in more detail the very useful tools also used in the field of nutrition economics, such as cost-of-disease studies, cost-effectiveness studies and budget impact. We analyze different works that have allowed us to advance in these fields in recent years. Finally, the difficulties related to the financing of nutrition in the centers as well as the regulation of enteral nutrition in the home are analyzed. The creation of value in clinical nutrition is a task for everyone (healthcare professionals, patients, managers and the pharmaceutical industry)
Asunto(s)
Humanos , Terapia Nutricional/economía , Análisis Costo-Beneficio , Costo de Enfermedad , Nutrición Enteral , Financiación de la Atención de la Salud , Servicios de Atención de Salud a DomicilioRESUMEN
BACKGROUND: Faced with increasing health care costs, it is incumbent to discern whether managing dyslipidemia with medical nutrition therapy (MNT) by a registered dietitian nutritionist (RDN) is clinically and cost effective. OBJECTIVE: To systematically examine evidence on the clinical effectiveness and cost benefit of MNT by an RDN for the treatment of dyslipidemia. METHODS: English and full-text research articles published between January 2003 and October 2014 were identified using PubMed, MEDLINE, and the Worldcat.org site to identify literature specific to clinical and cost effectiveness of MNT for dyslipidemia. Studies were required to have at least one outcome measure of dyslipidemia: total cholesterol (Total C), low-density lipoprotein cholesterol, triglycerides, high-density lipoprotein cholesterol, and/or metabolic syndrome. RESULTS: This systematic review identified 34 primary studies with 5704 subjects. Multiple individual face-to-face MNT sessions by an RDN over 3 to 21 months led to significant improvements in lipid profile, body mass index, glycemic status, and blood pressure. Results were summarized as mean differences with 95% confidence intervals when meta-analysis was possible. In a pooled analysis, MNT interventions lowered low-density lipoprotein cholesterol, total C, triglycerides, fasting blood glucose, hemoglobin A1c, and body mass index compared to a control group. Cost effectiveness and economic savings of MNT for dyslipidemia showed improved quality-adjusted life years and cost savings from reduced medication use. CONCLUSION: Evidence from this systematic review and meta-analysis demonstrates that multiple MNT sessions by an RDN are clinically effective and cost beneficial in patients with dyslipidemia and cardiometabolic risk factors.
Asunto(s)
Análisis Costo-Beneficio , Dislipidemias/dietoterapia , Terapia Nutricional/economía , Nutricionistas , Dislipidemias/metabolismo , Dislipidemias/fisiopatología , Humanos , Resultado del TratamientoRESUMEN
BACKGROUND: Acute malnutrition is currently divided into severe (SAM) and moderate (MAM) based on level of wasting. SAM and MAM currently have separate treatment protocols and products, managed by separate international agencies. For SAM, the dose of treatment is allocated by the child's weight. A combined and simplified protocol for SAM and MAM, with a standardised dose of ready-to-use therapeutic food (RUTF), is being trialled for non-inferior recovery rates and may be more cost-effective than the current standard protocols for treating SAM and MAM. METHOD: This is the protocol for the economic evaluation of the ComPAS trial, a cluster-randomised controlled, non-inferiority trial that compares a novel combined protocol for treating uncomplicated acute malnutrition compared to the current standard protocol in South Sudan and Kenya. We will calculate the total economic costs of both protocols from a societal perspective, using accounting data, interviews and survey questionnaires. The incremental cost of implementing the combined protocol will be estimated, and all costs and outcomes will be presented as a cost-consequence analysis. Incremental cost-effectiveness ratio will be calculated for primary and secondary outcome, if statistically significant. DISCUSSION: We hypothesise that implementing the combined protocol will be cost-effective due to streamlined logistics at clinic level, reduced length of treatment, especially for MAM, and reduced dosages of RUTF. The findings of this economic evaluation will be important for policymakers, especially given the hypothesised non-inferiority of the main health outcomes. The publication of this protocol aims to improve rigour of conduct and transparency of data collection and analysis. It is also intended to promote inclusion of economic evaluation in other nutrition intervention studies, especially for MAM, and improve comparability with other studies. TRIAL REGISTRATION: ISRCTN 30393230 , date: 16/03/2017.
Asunto(s)
Servicios de Salud del Niño , Trastornos de la Nutrición del Niño/dietoterapia , Trastornos de la Nutrición del Lactante/dietoterapia , Desnutrición/dietoterapia , Terapia Nutricional/métodos , Servicios de Salud Rural , Servicios Urbanos de Salud , Enfermedad Aguda , Factores de Edad , Desarrollo Infantil , Servicios de Salud del Niño/economía , Trastornos de la Nutrición del Niño/diagnóstico , Trastornos de la Nutrición del Niño/economía , Trastornos de la Nutrición del Niño/fisiopatología , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Análisis Costo-Beneficio , Estudios de Equivalencia como Asunto , Femenino , Alimentos Formulados , Alimentos Fortificados , Costos de la Atención en Salud , Humanos , Lactante , Trastornos de la Nutrición del Lactante/diagnóstico , Trastornos de la Nutrición del Lactante/economía , Trastornos de la Nutrición del Lactante/fisiopatología , Kenia , Masculino , Desnutrición/diagnóstico , Desnutrición/economía , Desnutrición/fisiopatología , Estudios Multicéntricos como Asunto , Terapia Nutricional/economía , Estado Nutricional , Servicios de Salud Rural/economía , Sudán , Factores de Tiempo , Resultado del Tratamiento , Servicios Urbanos de Salud/economía , Aumento de PesoRESUMEN
Introducción: la desnutrición relacionada con la enfermedad (DRE) tiene una alta prevalencia e importantes repercusiones clínicas y económicas. Nuestro objetivo es valorar la factibilidad e importancia de establecer una estrategia de cribado nutricional en nuestro medio. Pacientes y métodos: estudio prospectivo realizado en una planta quirúrgica. Se realizó el Malnutrition Universal Screening Tool (MUST) al ingreso y semanalmente, hasta el alta hospitalaria, a todos los pacientes. Cuando fue necesario, se realizó valoración e intervención nutricional así como codificación al alta de los diagnósticos y procedimientos nutricionales. Datos de estancia hospitalaria (EH), costes hospitalarios y parámetros clínicos fueron analizados posteriormente. Resultados: en un 15,6% de pacientes, el MUST detectó riesgo de desnutrición (≥ 2 puntos). Los pacientes con desnutrición al ingreso (DI) presentaron una estancia hospitalaria (EH) cuatro días superior y mayor tasa de mortalidad y de reingresos urgentes (2,4 y 2,0 veces, respectivamente), un año después del alta hospitalaria. La edad y el ingreso urgente fueron los factores asociados a mayor tasa de mortalidad anual. Un 9% de los pacientes con MUST < 2 inicial sufrieron un deterioro del estado nutricional (DEN) durante el ingreso. Estos pacientes, tuvieron mayor EH (siete días) a igualdad de comorbilidad. Considerando los costes relacionados con la EH, en los pacientes que presentaron DI o DEN se observó un sobrecoste del 57% y el 145%, respectivamente. Conclusión: los pacientes con DI presentaron mayor EH y tasa de mortalidad y de reingresos urgentes un año después del alta hospitalaria. Los pacientes con DI o DEN ocasionan un sobrecoste económico. El cribado nutricional es indispensable para el manejo y la detección precoz de la DRE
Introduction: disease-related malnutrition (DRM) is currently a major challenge in our hospitals, both because of its high prevalence and because of the clinical and economic impact. Our study aims to assess the feasibility and importance of establishing a nutritional screening strategy in our Health Care System. Patients and methods: this is a prospective study carried out in a Surgery Ward. The nutritional risk was assessed by applying to patients MUST at admission and weekly until discharge. Nutritional evaluation and nutritional intervention were performed if required, as well as coding of diagnoses and nutritional procedures at discharge. Clinical data, length of stay (LOS) and hospital costs were analyzed. Results: MUST detected 15.6% of patients at risk of malnutrition at admission. Patients with malnutrition at admission (MA) had four days longer LOS, higher annual mortality rate and urgent hospital readmissions in 2.4 and 2.0 times, respectively, one year after discharge. Age and urgent hospital admission were the factors associated with a higher annual mortality rate. Nine per cent of patients with an initial MUST < 2 suffered deterioration in their nutritional status during admission (DNS). These patients had longer LOS in seven days with equal comorbidity. Considering only the costs related to LOS in patients who presented MA or DNS, an overcost of 57% and 145%, respectively, was observed. Conclusion: patients with malnutrition on admission had longer LOS, higher mortality rate and urgent hospital readmissions one year after discharge. Patients who present MA or DNE cause an economic cost overrun. A nutritional screening tool is essential for the management and early detection of DRM
Asunto(s)
Humanos , Desnutrición/epidemiología , Hospitalización/estadística & datos numéricos , Terapia Nutricional/economía , Estudios Prospectivos , Estadísticas Hospitalarias , Evaluación Nutricional , Estado Nutricional , Apoyo Nutricional/estadística & datos numéricos , Valor Predictivo de las Pruebas , Comorbilidad , Costos de la Atención en SaludRESUMEN
INTRODUCTION: Malnutrition in hospitalized patients is not evaluated frequently. However, it is a critical issue given that it has been related to a high rate of infectious complications and increased mortality rates. There is a high prevalence of patients with nutritional impairment in the home environment, which favors their clinical worsening, the increase of re-hospitalizations and, consequently, the increase in public health expenditures. OBJECTIVE: Nutrition experts have thoroughly discussed and written this positioning paper on hospital and homecare malnutrition to describe the prevalence of malnutrition in Brazil. Best practice recommendations for nutrition therapy of patients in hospital and homecare, in particular the use of oral nutritional supplements (ONS), to those who are at risk of malnutrition or malnourished were evaluated, and the impact on clinical and economic data were assessed. In addition, they emphasize that investments in oral nutritional supplementation are also important in the homecare environment (home or nursing homes). MATERIALS AND METHODS: Selected scientific articles on disease-related malnutrition, especially those carried out in Brazil, were assessed. Data on prevalence, clinical outcomes, and economic burdens were reviewed. RESULTS AND CONCLUSION: Several studies have shown the importance of in-hospital nutritional assessment for early detection of malnutrition and early intervention with nutrition therapy, in particular with oral nutritional therapy. Unfortunately, hospital malnutrition remains high in Brazil, with severe consequences for patients. The implementation of universal nutritional screening and diagnosis as well as the therapeutic approach of malnutrition, particularly with the use, when possible, of oral nutrition supplements as the first step to address this condition is still low, and demands the investment in educational resources to change practices. Routine use of nutritional therapy in hospital and homecare settings improves clinical outcomes, is cost effective, and would be expected to help reduce healthcare costs.
Asunto(s)
Servicios de Atención de Salud a Domicilio , Hospitalización , Desnutrición/terapia , Terapia Nutricional/métodos , Brasil/epidemiología , Humanos , Desnutrición/economía , Desnutrición/epidemiología , Evaluación Nutricional , Terapia Nutricional/economía , Prevalencia , Salud PúblicaRESUMEN
Objective: To evaluate the prescribed volume of enteral feeding versus the volume infused, identifying the diet for interruption, and expenses generated by these interruptions. Methods: Observational study with adults and elderly patients receiving enteral nutrition in a private hospital in São Paulo. Data collection was performed by means of electronic medical records. Results: The infused volume was significantly lower than the amount prescribed in the five days of monitoring in the entire sample. The main complication in the experimental diet was diarrhea. Spending on non-diet administration amount to 41.4% of the amount spent for this service. Conclusion: This study contributes to the performance and nutritionist performance in conjunction with the multidisciplinary team in Nutrition Therapy aiming at the improvement of the patient.
Objetivo: Avaliar o volume prescrito de dieta enteral versus o volume infundido, identificando as causas de interrupção da dieta e os gastos gerados por essas interrupções. Métodos: Estudo observacional, com pacientes adultos e idosos, recebendo nutrição enteral em um hospital particular de São Paulo. A coleta de dados foi realizada por meio de prontuário eletrônico. Resultados: O volume infundido foi significantemente menor que o volume prescrito, nos cinco dias de acompanhamento, em toda a amostra. A principal intercorrência na administração da dieta foi a diarreia. Os gastos com a não administração da dieta somam 41,4% do valor despendido para esse serviço. Conclusão: Este estudo contribui para a atuação e desempenho do nutricionista em conjunto com a Equipe Multidisciplinar em Terapia Nutricional visando a melhora do paciente.
Objetivo: Evaluar el volumen prescrito de la alimentación enteral en comparación con el volumen infundido, la identificación de la dieta para la interrupción y gastos generados por estas interrupciones. Métodos: Estudio observacional con pacientes adultos y ancianos que reciben nutrición enteral en un hospital privado de Sao Paulo. La recolección de datos se realizó por medio de registros médicos electrónicos. Resultados: El volumen infundido fue significativamente menor que la cantidad prescrita en los cinco días de monitoreo en toda la muestra. La complicación principal de la dieta experimental fue la diarrea. El gasto en cantidad de administración no dietética al 41,4% de la cantidad gastada por este servicio. Conclusión: Este estudio contribuye al rendimiento y desempeño en nutrición en conjunto con el equipo multidisciplinario en el tratamiento nutricional destinado a la mejora del paciente.