Managing postacute malnutrition (undernutrition) risk.

Area of Science:

• Clinical Nutrition
• Healthcare Policy
• Patient Outcomes

Background:

• Undernutrition in hospitalized patients is linked to adverse outcomes post-discharge.
• Dietary nonadherence after discharge is a significant factor in heart failure (HF) readmissions.
• Current nutrition assessment criteria differ significantly between admission and post-discharge care.

Purpose of the Study:

• To highlight the importance of nutrition screening prior to hospital discharge.
• To identify factors critical for developing and implementing effective post-acute nutrition care plans.
• To delineate nutrition-related contributors to HF readmissions.

Main Methods:

• Characterization of the U.S. healthcare environment concerning readmission policies (CMS, October 2012).
• Identification of transitional care models adaptable for enhanced nutrition care.
• Emphasis on a multidisciplinary approach including care coordination and follow-up.

Main Results:

• While direct correlation is not yet established, undernourished patients are at increased risk.
• Robust evidence links dietary nonadherence in HF patients to increased readmissions.
• Key factors for successful post-acute nutrition care plan implementation are described.

Conclusions:

• Nutrition screening should be mandated prior to discharge, similar to admission screening.
• Transitional care models and multidisciplinary approaches are essential for effective nutrition care.
• An evidence-based approach is needed to determine appropriate palliative versus restorative nutrition care.