Addressing Malnutrition Across the Continuum of Care: Which Patients Are Likely To Receive Oral Nutritional Supplements - Addressing Malnutrition Across the Continuum of Care: Which Patients Are Likely To Receive Oral Nutritional Supplements - Open Access Pub

Oral nutritional supplements (ONS) have been shown to improve patient outcomes in the hospital setting, but limited results from long-term care or community settings exist. Using electronic health records (EHRs) from 2009 to 2014 for both adult inpatients and outpatients, we compare the demographic and clinical characteristics of patients who received ONS (n = 1,251) with a non-ONS control group (n =25,513). Multivariable logistic regression modeling was used to describe and compare differences in baseline characteristics between the groups including age, sex, race, tobacco use, and comorbidities. We found that patients receiving ONS were older and sicker than control patients. Hospitalized ONS patients were more likely to be admitted from the emergency department and have a hospitalization within the last month prior to the index date. Our results suggest that there is a need for nutrition screening and incorporating nutrition status into the EHR as an important way to coordinate hospital and community medical care. ONS can be an important therapy for vulnerable populations in both the hospital and the community settings. DOI10.14302/issn.2474-7785.jarh-16-1398 Malnutrition is a serious and undertreated problem in both the hospital and community settings. Malnourished patients face greater risk of poor functional, clinical, and economic outcomes. For example, poor nutritional status is associated with a heightened risk of comorbid complications 1, 2, longer hospital length of stay (LOS) 3, 4, higher health care costs 5, 6, more frequent readmissions 7, 9, and an increased risk of mortality 10. Malnutrition is prevalent in 30-50% of patients at the time of hospital admission 11, 12, 13, depending on the location and the specific patient population considered. In the outpatient community population, the prevalence of malnutrition is 7.2%-30% 14, 15, 16. Yet, despite the magnitude of malnutrition and evidence demonstrating the resulting adverse clinical and economic effects, malnutrition continues to be under-recognized and undertreated 17. A growing body of evidence has shown oral nutritional supplements (ONS), which consist of both macronutrients and micronutrients, to be a cost-effective way to prevent and treat malnutrition and to improve patient outcomes 18, 19. However, ONS is a therapy that is often overlooked in community health 20, which is at the intersection of inpatient and outpatient services. This study aims to better understand the delivery of ONS as an important therapy in both inpatient and outpatient settings, with patients in the