Showing posts with label Wellness. Show all posts
Showing posts with label Wellness. Show all posts

Saturday, August 7, 2021

A three-step nutrition intervention model associated with better health outcomes and reduced costs

Improving health outcomes while reducing costs, regardless of the setting of care, includes an often overlooked and rarely discussed element that has the potential to prohibit success on both fronts: nutrition health. Understanding and addressing patients' nutrition status is often a key component of reducing the length of hospital stays, decreasing the use of medical resources and lowering the total cost of care.



The Burden of Malnutrition


According to the World Health Organization, malnutrition is defined as an imbalance, deficiency, or sub-optimal intake of nutrients.1 Whether undernourished or overnourished, the effects of malnutrition can be harmful to achieving good health, and costly for patients and the larger healthcare system alike. In the United States, the cost of disease-associated malnutrition stemming mainly from conditions such as cancer or cardiovascular disease has been estimated at more than $147 billion per year, with $15.5 billion attributed directly to treatment costs.2,3 But health systems aren’t the only ones bearing the burden—people who are hospitalized and found to be malnourished may incur hospital costs nearly twice as high as those who are adequately nourished.4

Comprehensive nutrition care that delivers the nutrients patients need can support care across the continuum, including in hospitals, outpatient clinics, and community care settings. Furthermore, intentional effort to ensure patients are receiving proper nutrition improves overall patient health and reduces the use of healthcare resources and costs.




One Model to Address Malnutrition Across Care Settings Equals Better Outcomes for All


Healthcare providers often have only a few minutes to connect with their patients to evaluate their condition and address their concerns, which means that many may feel they don’t have enough time to discuss important topics with their patients like diet and nutrition. By implementing simple but comprehensive nutrition programs, healthcare providers can screen for undernutrition or overnutrition to assess risk and quickly determine if further intervention is needed. This screening includes a three-step approach:


1. Screen Patients to Determine Malnutrition Risk


Screen patients for undernutrition or overnutrition risk with a few simple questions such as: Has food intake reduced recently? Have they lost weight without trying? Have they experienced a recent illness or injury that suggests they may be undernourished? Have they noticed weight gain within the past 3-6 months? Have they noticed a change in fitting of clothing recently?


2. Communicate a Personalized Nutrition Care Plan


Create a customized plan for patients at risk for malnutrition and recommend an appropriate nutritional drink such as Ensure or Glucerna to help patients get the nutrients they need.


3. Deliver Nutrition Education


Educate patients and their caregivers on the importance of nutrition and nutritional drinks compliance.

When introduced as part of a comprehensive nutrition program, these three steps provide a model that has been successful in acute care settings, like hospitals where results from a study by Advocate Health Care and healthcare company Abbott included cost savings of nearly $4,000 per patient, shortened length of hospital stays, and reduced readmission rates.5,6 Another study by Advocate Health Care and Abbott which implemented a similar nutrition program using these three steps for patients at risk for malnutrition in transitional care touchpoints like home healthcare settings has also shown to have significantly reduced hospitalization rates and healthcare costs by an estimated $1,500 per patient treated.7




Quality of Care is Everyone's Priority


Stakeholders across the continuum of care benefit when people are properly nourished. And, when these benefits are realized, there is the ability to drive that value in communities by improving the health of the members within it. The three clinics that participated in the study and implemented a nutrition program saw a significant decrease in the percentage of patients using healthcare resources over 90 days, allowing healthcare providers to better manage their patients while reducing costs. The quality of care also improved, with 81.8% of patients reporting high levels of satisfaction with their nutrition care.8,9

While managing costs is important to leaders in healthcare practices and systems responsible for managing healthcare expenditure, healthcare professionals and administrators are generally more concerned about delivering quality care to their patients and enabling healthy outcomes for long-term success.

When nutrition is considered as a component of the overall treatment plan, patients can feel better about the holistic regimen of care they are receiving to actively treat symptoms and successfully manage conditions. To bring the value of nutrition to healthcare, healthcare authorities have an opportunity to develop effective practices, policies, and comprehensive malnutrition strategies for implementation across the continuum of care at hospitals, post-acute or primary care settings, and at home, making our communities healthier for all.


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Thursday, June 27, 2019

How to discuss cognitive screenings with your Medicare patients

Most clinical screening tests are designed to give providers a heads up on the potential development of a disease. While most patients readily agree to screening tests, the idea of screening for any possible cognitive decline often is a scary topic for patients — and creates a complex decision-making situation for providers.


The Medicare Annual Wellness Visit, launched in 2011, includes coverage of cognitive screening services for Medicare beneficiaries every 12 months. The parameters of the program allow physicians to “assess the beneficiary’s cognitive function by direct observation while considering information from beneficiary reports and concerns raised by family members, friends, caregivers and others. If appropriate, use a brief validated structured cognitive assessment tool.” (CMS Medical Learning Network)

The wellness visit is the perfect opportunity to foster healthy conversations with patients about cognitive function and to explain that not all cognitive decline is caused by Alzheimer’s disease, says Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association. “A lot of cognitive decline is caused by things that are treatable, including sleep apnea, depression and other medical conditions.”

And primary care physicians (PCPs), who serve as the quarterback for coordinated care, see their patients frequently throughout the year and develop relationships over years, have the distinct advantage of knowing their patients. They may be able to detect changes that go overlooked or ignored by friends and family. Plus, the physician-patient relationship may be the only one where the topic of cognitive screenings won’t be met with a strong emotional response.


Cognitive screening recommendations


The medical community’s acceptance of cognitive screenings is still a mixed bag, partly because of inadequate research indicators amid an incredibly complex neurological field. The U.S. Preventive Services Task Force (USPSTF), an independent body that develops recommendations for clinical preventive services, issued a decision of insufficient evidence of the benefits in 2014 but revisited the topic in 2017 through a detailed review of cognitive conditions and possible interventions.

The taskforce chose not to change its original view of insufficient evidence of benefits, but it recognized that mild cognitive impairment (MCI) is a unique condition among other cognitive diseases that merits more research on the benefits of screening and intervention.

While the USPSTF’s position remains one of caution, it does open the doors for more research on MCI and the development of better screening for early cognitive decline, writes the AAFP: “The diagnosis of dementia currently is initiated mostly on the basis of a clinician's suspicion regarding patient symptoms or caregiver concerns, and although the evidence for routine screening is insufficient, there may be important reasons to identify early cognitive impairment.”

However, the indicators for prompting a cognitive assessment can be a gray area for physicians: It’s a detective hunt of medical and mental hints that includes a close analysis of the health risk assessment, physicians’ own observations and patients’ responses to in situ questions. The need for a cognitive assessment also relies greatly on self-reported symptoms, so it’s crucial that physicians engage patients and their families in healthy, proactive conversations about cognition as a normalized topic during wellness exams.


So, which cognitive screening tests are recommended for use in a Medicare Annual Wellness Visit, and under what circumstances is further testing indicated?


The Alzheimer’s Association has developed a physician flowchart designed and approved for use during the Medicare Annual Wellness Visit. It outlines a suggested clinical decision-making process and recommends specific screening tests based on physician observations and the patient’s own responses. The screening tests can be administered in less than 10 minutes apiece and may reveal important data indicating the need for further testing.

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