Clinical and Economic Outcomes of Nutrition Interventions Across the Continuum of Care

Clinical and Economic Outcomes of Nutrition Interventions Across the Continuum of Care

Thursday, March 13, 2014

The Omni Shoreham in Washington DC

Presented By

Presented by Abbott Nutrition Health Institute and The Sackler Institute for Nutrition Science

 

Abbott Nutrition Health Institute (RO002), is a Continuing Professional Education (CPE) Accredited provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDs) and dietetic technicians, registered (DTRs) will receive 5 continuing professional education unit (CPEU) for completion of this program/material. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials.


Optimal nutrition across the continuum of care plays a key role in the short- and long-term clinical and economic outcomes of patients. Nutrition interventions have the potential to provide cost-effective preventive care and treatment measures. However, limited data exists on the economics and impact evaluations of these interventions. On March 13, 2014, nutrition and health system researchers and practitioners, economists and policymakers will gather to discuss emerging research on nutrition health economics, the role of nutrition interventions across the continuum of care, and how nutrition can affect healthcare costs. The conference is presented jointly by the Abbott Nutrition Health Institute, The Sackler Institute for Nutrition Science, and the New York Academy of Sciences.

*Reception to follow.

 

Registration Pricing

 By 2/28/2014After 2/28/2014Onsite
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Registration fee includes a complimentary one-year individual membership to the New York Academy of Sciences. To view all member benefits, visit www.nyas.org/Membership. One-year individual membership only applies to non-members and cannot be used to extend membership for current member.


Presented by

  • Abbott Nutrition Health Institute
  • Sackler
  • a program of The New York Academy of Sciences

Agenda

* Presentation titles and times are subject to change.


Thursday, March 13, 2014

8:00 AM

Registration and Continental Breakfast

9:00 AM

Welcoming Remarks
Mandana Arabi, MD, PhD, The Sackler Institute for Nutrition Science
Rosemary E. Riley, PhD, LD, Abbott Nutrition Health Institute

9:15 AM

Keynote
The New Malnutrition: Challenges of Changing the Paradigm Globally
Kelly Tappenden, PhD, RD, FASPEN, University of Illinois

Session I: Malnutrition Data and Insights from Around the World

9:45 AM

Insights from the Canadian Malnutrition Task Force
Leah Gramlich, MD, FRCP, University of Alberta

10:15 AM

Malnutrition's Impact on Cost of Hospitalization, Length of Stay, and Readmission and Mortality in Singapore
Lim Su Lin, PhD, National University Hospital, Singapore

10:45 AM

Networking Coffee Break

11:15 AM

Malnutrition's Screening and Impact on Patient Outcomes
Marian de van der Schueren, PhD, VU University Medical Center, Amsterdam

11:45 AM

Consequences of Malnutrition on Oncology Treatment
Carla Prado, PhD, Florida State University

12:15 PM

Lunch

Session II: Nutrition Interventions, Costs, and Economic Benefits

1:15 PM

Impact of Oral Nutritional Supplementation on Hospital Outcomes
Tomas Philipson, PhD, University of Chicago

1:45 PM

The New Interventions Protocol in UK from a Systems Approach
Marinos Elia, MD, FRCP, University of Southampton

2:15 PM

Networking Coffee Break

2:45 PM

Nutrition Prevention Interventions to Address Malnutrition in the Community-living Elderly Populations
Hélène Payette, PhD, Université de Sherbrooke

3:15 PM

Nutrition in Post-Acute Care Settings: Screening and Intervention to Reduce Unnecessary Hospital Admissions
Michael Johnson, PT, PhD, OCS, Bayada Home Healthcare

3:45 PM

Panel: The Clinical Challenges of Nutrition
Marinos Elia, MD, FRCP, University of Southampton
Leah Gramlich, MD, FRCP, University of Alberta
Michael Johnson, PT, PhD, OCS, Bayada Home Healthcare
Lim Su Lin, PhD, National University Hospital, Singapore
Carla Prado, PhD, Florida State University

4:30 PM

Closing Remarks
Jamie Partridge, PhD, MBA, Abbott Nutrition Research and Development

4:40 PM

Reception

7:00 PM

Conference Adjourns

Speakers

Scientific Organizing Committee

Leah Gramlich, MD, FRCP

University of Alberta

Leah Gramlich is a gastroenterologist and physician nutrition specialist. She also acts as Medical Director for Nutrition Services in Alberta Health Services North and is President of the Canadian Nutrition Society. Leah welcomes the opportunity to address malnutrition, since it’s an important issue she sees on a daily basis.

Darius Lakdawalla, PhD

University of Southern California

Jamie Partridge, PhD, MBA

Abbott Nutrition

Jamie Partridge, PhD, MBA, joined Abbott Nutrition Research and Development as Director of Health Economics and Outcomes Research (HEOR) in April, 2012. The focus of her activities centers on HEOR initiatives being developed and expanded in the Therapeutic Nutrition Area, as well as expanding HEOR capacities and influence around the globe. Jamie comes from Abbott Vascular where she was Program Manager, Outcomes Research for HEOR supporting ABSORB bioresorbable scaffolds, XIENCE drug eluding stents, and MitraClip mitral valve repair systems. Prior to that she was a Research Specialist at the Center for Health Outcomes, Policy and Evaluation Studies (Center for HOPES) in the College of Public Health at The Ohio State University. She holds a PhD in Agriculture Economics from the University of Saskatchewan, an MBA in Finance and Operations Management from Indiana University, and a B.A. in Economics from the University of Illinois.

Tomas Philipson, PhD

University of Chicago

Tomas J. Philipson is the Daniel Levin Professor of Public Policy Studies in the Irving B. Harris Graduate School of Public Policy Studies at the University of Chicago, and a Founding Partner of Precision Health Economics. Philipson has also served in several public sector positions. He served as the senior economic advisor to the head of the Food and Drug Administration (FDA) during 2003-04 and to the head of the Centers for Medicare and Medicaid Services (CMS) in 2004-05. Philipson is the recipient of numerous international and national research awards. He has twice (in 2000 and 2006) been the recipient of the highest honor of his field: the Kenneth Arrow Award of the International Health Economics Association (for best paper in the field of health economics). In addition, he was awarded the Garfield Award by Research America in 2007 (for best paper in the field of health economics). Dr. Philipson received his MA and PhD in economics from the Wharton School at the University of Pennsylvania.

Rosemary E. Riley, PhD, LD

Abbott Nutrition Health Institute

Rosemary E. Riley, Ph.D, L.D., is senior manager, science programs for the Abbott Nutrition Health Institute, where she is responsible for developing and directing programs that educate health care professionals throughout the world on the importance of nutrition as therapy to improve patient outcomes. While at Abbott, Rosemary has worked on a variety of nutrition initiatives, including a comprehensive, multidisciplinary medically supervised weight management program, geriatric nutrition, sports nutrition, women's healthwith a focus on bone health-and diabetes. She also has experience in strategic discovery and evaluation of ingredients and technology to address these same health conditions.

Kelly Tappenden, PhD, RD, FASPEN

University of Illinois

Kelly Tappenden received her Ph.D. in Nutrition and Metabolism at the University of Alberta, underwent post-doctoral training at the University of Texas Medical School in Houston, and joined the faculty at the University of Illinois at Urbana in 1997 as Assistant Professor. She was promoted to Associate Professor in 2003, Professor in 2008 and invested as the Kraft Foods Human Nutrition Endowed Professor in 2012. In 2011 she was named a University of Illinois Distinguished Teacher-Scholar – the premier campus award recognizing excellence in teaching and learning. Dr. Tappenden’s research program focuses on intestinal failure and the parenteral nutrients required to prevent death from progressive malnutrition. Beyond her years of service on multiple national nutrition committees, Dr. Tappenden served as the 33rd President of the American Society for Parenteral and Enteral Nutrition in 2008-09. Currently, she is the Editor-in-Chief of the Journal for Parenteral and Enteral Nutrition.

Mandana Arabi, MD, PhD

The Sackler Institute for Nutrition Science

Amy Beaudreault, PhD

The Sackler Institute for Nutrition Science

Speakers

Marinos Elia, MD, FRCP

University of Southampton

Marinos Elia is Professor of Clinical Nutrition and Metabolism at the University of Southampton and Consultant Physician at Southampton General Hospital. He has served on many national and international committees, has chaired a number of them, including the British Association for Parenteral and Enteral Nutrition (BAPEN) and the NICE Quality Standard Topic Expert Group on Nutrition Support in Adults. He is currently the chairman of the International Society for Body Composition the Research and the Malnutrition Action Group (MAG) of BAPEN. In 2013 he also chaired the NICE Evidence Update Group and the NICE Clinical Commissioning Group Outcomes Indicator Set (CCGOIS) Review Group on Nutrition Support in Adults. He is a member of the editorial board of six nutrition journals, and has been editor-in-chief of Clinical Nutrition. He led teams that developed the ‘Malnutrition Universal Screening Tool’ (‘MUST’), the most widely used nutrition screening tool in the UK and other countries/states. He has published extensively on various aspects of nutritional biochemistry and body composition, and evidence-based medicine. He has received several national and international awards, including life-long honorary membership to ESPEN, BAPEN, the John Lenard-Jones medal, and Complete Nutrition Lifetime Achievement Award.

Leah Gramlich, MD, FRCP

University of Alberta

Michael Johnson, PT, PhD, OCS

Bayada Home Healthcare

Michael P. Johnson, PT, PhD, OCS, is Regional Director (Mid-Atlantic Group) for the Home Health Practice at BAYADA Home Health Care in Moorestown, NJ. As a member of the senior leadership team, he is involved in strategic planning, business development, operational support, and overall quality improvement for the practice. Dr. Johnson is responsible for 1) providing operational support to six divisions (comprising 36 home health offices) in PA, NJ, DE, and MD as well as 2) leading a multidisciplinary team of professionals in supporting all aspects of interdisciplinary home health clinical practice across 75 offices in 17 states. From of clinical perspective, he is accountable for the development and implementation of evidence-based best practice clinical guidelines and oversight of clinical research activities, continuous quality improvement initiatives, regulatory compliance (federal and state), and best practices for recruitment, orientation, and development of nursing, social work, and physical, occupational, and speech therapy professionals. Dr. Johnson is a member of the National Advisory Council (NAC) for the Agency for Healthcare Research and Quality (AHRQ) and serves as a Steering Group member for the AQA Alliance, a large voluntary multi-stakeholder collaborative focused on improving patient safety, health care quality and value in all settings.

Hélène Payette, PhD

Université de Sherbrooke

Hélène Payette is a dietitian and Professor in the Faculty of Medicine and Health Sciences at the University of Sherbrooke, specializing in nutrition, epidemiology and aging. She is also a Senior Researcher at the Research Centre on Aging, focusing on malnutrition in the frail elderly, nutrition screening, determinants of healthy eating and impact of nutritional status on functional capacities in the aging individual. Hélène is currently co-investigator for the Canadian Longitudinal Study on Aging and principal investigator for the Quebec Longitudinal Study on Nutrition as a Determinant of Successful Aging (NuAge).

Tomas Philipson, PhD

University of Chicago

Carla Prado, PhD

Florida State University

Dr. Carla Prado has extensive experience in nutritional/metabolic assessment of patients with cancer. The focus of her research program is the relationship between abnormal body composition and health outcomes in patients with malignant disease. Her research has shown for the first time the prevalence and clinical implications of sarcopenic obesity in cancer, and has provided evidence of the independent effect of body composition on cancer recurrence, treatment and survival. Dr. Prado received her Ph.D. from the University of Alberta, Canada, and has completed further training at the Cross Cancer Institute (Canada), the National Institutes of Health (USA) and Newcastle University (UK).

Lim Su Lin, PhD

National University Hospital, Singapore

Su Lin is the Chief Dietitian and Senior Assistant Director of the Dietetics Department at the National University Hospital, Singapore. She is best known for her work on hospital malnutrition in Singapore. She and her team developed the 3-Minute Nutrition Screening Tool, which has been validated and published, and is currently being used across multiple hospitals and nursing homes in Singapore and Malaysia. Her recent study on hospital malnutrition demonstrated that malnutrition is an independent predictor of poor outcomes. This study was the first to control for the confounding effect of diagnosis-related groups when examining the impact of malnutrition on clinical outcomes. Su Lin has received numerous awards on her research and quality improvement initiatives. At the national level, she has won the NHG Best Oral Presentation in the year 2006, NHG Young Investigator’s Award in 2007, Singapore Allied Health Award for best oral presentation for 3 consecutive years from 2009 to 2011, and again in 2013. She was awarded the Singapore National Day-Efficiency Medal in year 2007 and was a Gold Medallist for the Singapore Public Service 21 Excellence Award in 2011. Dr Lim Su Lin received her PhD in Clinical Nutrition from the Queensland University of Technology in Australia.

Kelly Tappenden, PhD, RD, FASPEN

University of Illinois

Marian de van der Schueren, PhD

VU University Medical Center, Amsterdam

Marian de van der Schueren (RD, PhD) is a senior research nutritionist at the VU University Medical Center in Amsterdam and a professor of Nutrition at the HAN University of Applied Sciences. She registered as a dietitian in 1986. Se worked as a clinical dietitian for 8 years before starting her PhD studies. She obtained a PhD on “Malnutrition in head and neck cancer patients” in 2000. She became head of the department of nutrition and dietetics of the VU University Medical Center and in 2001 and has successfully contributed to the prosperous development of the department of nutrition and dietetics of the VUmc by establishing research lines and introducing evidence based practice into patient care. From 2009, she devotes her work to research only. In 2013 she was appointed a professor of Nutrition at the HAN University of Applied Sciences. Her fields of interest are: malnutrition, nutritional screening and assessment, geriatrics and cancer. She is a board member of several national and international committees, e.g. the Dutch Malnutrition Steering Group, the Dutch Society for Clinical Nutrition and Metabolism and the European Society for Clinical Nutrition and Metabolism. She participates in several advisory groups, for example for the Dutch Dietetic Association and the Health Council of the Netherlands. She is an associated editor for Clinical Nutrition, the Journal of Human Nutrition and Dietetics, and the Dutch Journal for Dietitians.

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Presented by

  • Abbott Nutrition Health Institute

Abstracts

MALNUTRITION: PERSPECTIVES FROM THE CANADIAN MALNUTRITION TASK FORCE (CMTF)
Leah Gramlich, MD
Department of Medicine, University of Alberta, Edmonton, Alberta
Provincial Medical Advisor, Nutrition Services, Alberta Health Services

The Canadian Malnutrition Task Force was convened in 2010 to assess the prevalence of malnutrition and obesity at hospital admission and their impact on hospital stay and 30 day re-admission. Pre-admission contributors to malnutrition were also evaluated. Eighteen acute care hospitals, academic and community, from 8 provinces across Canada, between July 1, 2010 and February 28, 2013 were included in the study. We measured subjective global assessment (SGA), body mass index (BMI) and handgrip strength at admission and assessed pre-admission contributors to malnutrition and nutrition care during hospitalization. The main outcomes were length of hospital stay and re-admission within 30-day post discharge. Of 1022 patients enrolled: 45% were malnourished (SGA B+C) at admission and 32% were obese (BMI > 30 kg/m2). Independent factors associated with malnutrition included Charlson comorbidity index (CCI) >2, having 3 diagnoses, relying on adult children for grocery shopping and living alone. Malnutrition (SGA B+C) was independently associated with prolonged hospital stay. Other nutritional care factors independently associated with prolonged stay were: NPO for at least 3 days, presence of nutritional support and an estimated average food intake < 50% during the first week. Malnutrition at admission (SGA B+C) was also associated with an increased probability of readmission independently of other factors. Several strategies have emerged from this work that need prioritization in order to integrate nutrition care in hospitalized patients. These include the mandate for malnutrition screening, optimizing interprofessional function, attention to nutrition care in hospitalized patients and ongoing support of knowledge translation strategies to enhance nutrition care of hospitalized patients, inclusive of assessment, intervention and follow-up.

NUTRITION IN POST-ACUTE CARE SETTINGS: SCREENING AND INTERVENTION TO REDUCE UNNECESSARY HOSPITAL ADMISSIONS
Michael P. Johnson, PT, PhD
BAYADA Home Health Care, Moorestown, NJ

Malnutrition and age-related muscle loss or sarcopenia have serious health and economic consequences. Muscle loss is highly prevalent in those >65 years and leads to negative outcomes such as functional decline, hospitalizations, and poor quality of life. Illness often exacerbates muscle loss leaving many clients unable to consume sufficient calories and protein needed for recovery. Oral nutrition supplements (ONS), as part of overall medical care, can help improve quality patient care by helping lower the incidence of: hospitalizations, wounds/infections, and falls.

The role of nutrition is vital as we look toward achieving the Triple Aim of Healthcare; improving population health, enhancing the experience of care, and lowering costs. This presentation reviews clinical evidence on the relationship between malnutrition and quality outcomes in patient care. BAYADA Home Health Care and Abbott Nutrition have been collaborating in an on-going Quality Improvement initiative to implement early nutrition screening and intervention for homecare clients to decrease hospitalizations, which will be the basis for discussing this relationship in the home health setting. We will review the process of establishing a screen and intervene program, initial pilot outcomes (all-cause hospitalization rate of 8.7% compared to 24.3%), implementation of a practice wide, structured process for nutrition risk assessment and intervention, and ongoing results and knowledge gained during 2 1/2 years of experience with this effort which confirm a clear relationship between malnutrition risk and unplanned hospitalization in both the post-acute and pre acute settings.

MALNUTRITION’S IMPACT ON COST OF HOSPITALIZATION, LENGTH OF STAY, READMISSION AND MORTALITY IN SINGAPORE
Su Lin Lim
Dietetics Department, National University Hospital, Singapore.
School of Exercise and Nutritional Science, Queensland University of Technology, Australia

The confounding effect of disease on the outcomes of malnutrition has seldom been studied in a multidisciplinary setting. Controlling for diagnosis-related groups (DRG), the speaker will share her research of malnutrition’s impact on cost of hospitalization, length of stay, readmission and 3-year mortality in Singapore. This prospective cohort study included a matched case control study on 818 adult patients newly admitted to the hospital. Hospitalization outcomes over 3 years were adjusted for gender, age, ethnicity, and matched for DRG.

The results showed that malnourished patients had longer hospital stays (6.9 ± 7.3 days vs. 4.6 ± 5.6 days, p < 0.001) and were more likely to be readmitted within 15 days (adjusted relative risk = 1.9, 95% CI 1.1–3.2, p = 0.025). Within a DRG, the mean difference between actual cost of hospitalization and the average cost for malnourished patients was greater than well-nourished patients (p = 0.014). Mortality was higher in malnourished patients at 1 year (34% vs. 4.1 %), 2 years (42.6% vs. 6.7%) and 3 years (48.5% vs. 9.9%); p < 0.001 for all. Overall, malnutrition was a significant predictor of mortality (adjusted hazard ratio = 4.4, 95% CI 3.3-6.0, p < 0.001). The speaker will also briefly share on subsequent strategies adopted hospital-wide for managing hospital malnutrition, from screening on admission and referral for assessment, to intervention and post-discharge follow-up. These interventions, some sustained for up to 5 years, have produced improved outcomes in nutrition status, function and patients’ quality of life.

CONSEQUENCES OF MALNUTRITION ON ONCOLOGY TREATMENT

Carla Prado, PhD, Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida.

Cancer is a disease associate with severe malnutrition caused by a variety of neural, nutritional, pro-inflammatory and autocrine/endocrine factors that ultimately culminate in an imbalance between anabolism and catabolism. Malnutrition during cancer disease trajectory is often manifested as skeletal muscle depletion assessed by body composition.

Body composition research has demonstrated a wide variability in muscle and adipose tissue regardless of body weight or body mass index. Skeletal muscle depletion has emerged as an important and independent predictor of poorer outcomes for oncology treatment affecting chemotherapy toxicity, outcomes of surgery, tumor progression, as well as survival.

The importance of malnutrition on oncology treatment emphasizes the value of nutritional assessment as well as the need to develop appropriate interventions to countermeasure losses of muscle mass. Recent evidence suggests a window of opportunity for anabolism earlier within the disease trajectory and may be an opportune time for randomized control trials of emerging new interventions that stop or reverse muscle loss.


IMPACT OF ORAL NUTRITIONAL SUPPLEMENTATION ON HOSPITAL OUTCOMES

Tomas Philipson, PhD
University of Chicago, Chicago, IL

This study assessed the effect of inpatient oral nutrition supplement (ONS) use on length of stay (LOS), episode costs and 30-day readmission rates. Analyses were conducted using the Premier Research Database (2000-2010) on hospitalized adult patients ≥18, Medicare patients ≥65, and subgroups of Medicare patients with diagnoses affected by Medicare reimbursement rules under the Affordable Care Act (ACA) -- acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia (PNA). One-to-one propensity-score matched samples of ONS and non-ONS episodes were created. To minimize bias, instrumental variables regression analyses were applied. 1.6% of all 44.0 million inpatient episodes involved ONS use. 20,870; 38,418; 47,477; 667,684; and 1.2 million ONS and matched non-ONS episodes were analyzed in the AMI, CHF, PNA, all ≥65, and all ≥18 samples, respectively. ONS use reduced LOS by 21.0% (p<0.01) in all ≥18 episodes, 16.0% (p<0.01) in all ≥65, 10.9% (p<0.01) in AMI, 14.2% (p<0.01) in CHF and 8.5% (p<0.01) in PNA. Episode costs decreased with ONS use in all ≥18, all ≥65, AMI, CHF and PNA by 21.6% (p<0.01), 15.8% (p<0.01), 5.1% (p<0.05), 7.8% (p<0.01) and 10.6% (p<0.01), respectively. Restricting the sample to episodes which could be tracked for follow-up, ONS reduced 30-day readmission rates by 6.7% (p<0.01), 8.4% (p<0.01), 12.0% (p<0.01) and 10.1% (p<0.01) in all ≥18, all ≥65, AMI and CHF, respectively. Use of ONS in hospitalized adult patients is associated with improved clinical outcomes and decreased health care costs and offers an inexpensive, evidence-based approach to meeting ACA quality targets.


THE NEW MALNUTRITION: CHALLENGES OF CHANGING THE PARADIGM GLOBALLY
Kelly Tappenden, PhD, RD, FASPEN
University of Illinois

The current era of healthcare delivery, with its focus on providing high-quality, affordable care, presents many challenges to hospital-based health professionals. The prevention and treatment of hospital malnutrition offer a tremendous opportunity to optimize the overall quality of patient care, improve clinical outcomes, and reduce costs. Unfortunately, malnutrition continues to go unrecognized and untreated in many hospitalized patients. The purpose of this presentation is to highlight the critical role of nutrition intervention in clinical care and to suggest practical ways to promptly diagnose and treat malnourished patients and those at risk for malnutrition. The content will underscore the importance of an interdisciplinary approach to addressing malnutrition both in the hospital and in the acute post-hospital phase. It is well recognized that malnutrition is associated with adverse clinical outcomes. Although data vary across studies, available evidence shows that early nutrition intervention can reduce complication rates, length of hospital stay, readmission rates, mortality, and cost of care. The key is to systematically identify patients who are malnourished or at risk and to promptly intervene. Important steps to drive improvement will emphasize the following 6 principles: (1) create an institutional culture where all stakeholders value nutrition, (2) redefine clinicians’ roles to include nutrition care, (3) recognize and diagnose all malnourished patients and those at risk, (4) rapidly implement comprehensive nutrition interventions and continued monitoring, (5) communicate nutrition care plans, and (6) develop a comprehensive discharge nutrition care and education plan.

Travel & Lodging

This event is offsite at The Omni Shoreham in Washington, DC

2500 Calvert Street NW (at Connecticut Ave.)
Washington, District of Columbia 20008
http://www.omnihotels.com/FindAHotel/WashingtonDCShoreham