Current nutrition practices and additional reimbursement of intensive care units in Japan: A cross-sectional survey...

A unique reimbursement for early nutrition intervention was introduced in Japan to promote guideline-adherent nutrition practices in intensive care units. However, the current status of nutrition therapy implementation across Japanese intensive care units remains unclear.

This cross-sectional survey study investigated intensive care units nationwide, led by the Japanese Society of Intensive Care Medicine. Facility characteristics, nutrition management structure, nutrition practices (nutritional assessment, nutrition planning, therapy implementation, and monitoring), and dietitian involvement were assessed. We examined relationships between reimbursement claim status and nutrition practices.

Among 337 intensive care units, most performed nutritional assessment using at least one standardized tool and planned nutrition targeting 25-30 kcal/kg/day for energy and 1.0-1.2 g/kg/day for protein. Enteral nutrition-related practices were widely implemented. Of these, 255 intensive care units (75.7%) claimed the reimbursement; incentivized units more frequently implemented written enteral nutrition protocols, dietitian-conducted nutritional assessments, dietitian-led enteral nutrition design, and enteral nutrition initiation within 48 h. However, Global Leadership Initiative on Malnutrition assessment, indirect calorimetry, written protocols for parenteral nutrition/diarrhea/constipation, dietitian-led parenteral nutrition design, and post-intensive care unit nutritional follow-up remained limited even in incentivized units.

In Japan, reimbursement incentives were positively associated with higher implementation of nutritional assessment, enteral nutrition-related practices, and dietitian involvement. To further advance specialized nutritional care, simultaneous system development may be warranted.