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Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among Medicare patients with COPD.
Chest. 2014 Oct 30;
Authors: Thornton Snider J, Jena AB, Linthicum MT, Hegazi RA, Partridge JS, LaVallee C, Lakdawalla DN, Wischmeyer PE
Abstract
Abstract: Background:Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability in the US. Patients with COPD are at high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplements (ONS) have 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:We first identified Medicare patients aged 65+ hospitalized with a primary diagnosis of COPD in the Premier Research Database. 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 1-1 matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also utilized instrumental variables (IV) analysis to study the effects of ONS. 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). IV analysis indicated that ONS use was associated with: a 1.88 day (21.5%) decrease in LOS, from 8.75 to 6.87 days (p<0.01); hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (p<0.01); and a 13.1% decrease in probability of 30-day readmission, from 0.335 to 0.291 (p<0.01). Conclusions:ONS may offer an inexpensive, effective means for reducing LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD.
Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability in the US. Patients with COPD are at high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplements (ONS) have 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: We first identified Medicare patients aged 65+ hospitalized with a primary diagnosis of COPD in the Premier Research Database. 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 1-1 matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also utilized instrumental variables (IV) analysis to study the effects of ONS. 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). IV analysis indicated that ONS use was associated with: a 1.88 day (21.5%) decrease in LOS, from 8.75 to 6.87 days (p<0.01); hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (p<0.01); and a 13.1% decrease in probability of 30-day readmission, from 0.335 to 0.291 (p<0.01).
Conclusions: ONS may offer an inexpensive, effective means for reducing LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD.
PMID: 25357165 [PubMed - as supplied by publisher]