Methods: Data from 2588 patients (1269 QIP patients enrolled October 2014-April 2015, and 1319 retrospective historical controls admitted in the QIP hospitals October 2013-April 2014) were categorized into diagnosis related groups (DRGs). The three largest DRGs from the 2588 patients were oncological (365, 14.1%), gastrointestinal (331, 12.8%), and cardiovascular (310, 12.0%). Given the small sample size for the remaining DRGs, comparative analysis (QIP versus historical controls) were pursued only for the three most commonly seen DRGs. Patients were identified during their stay at a participating QIP hospital, where the electronic medical record was upgraded to include a Malnutrition Screening Tool (MST) and condition-specific ONS was administered to all patients at risk for malnutrition (MST ≥ 2).
Results: Statistically significant reductions in readmission rates were reported for oncological (26.6% vs. 16.6%, p = 0.034) and cardiovascular (26.4% vs. 13.9%, p = 0.006) patient groups. Although the readmission rate for patients in the gastrointestinal group post-QIP was reduced, the reduction was not statistically significant (23.2% vs. 21.3%, p = 0.684). Pre-post length of stay results were significantly reduced in all three DRGs; specifically, 8.2 ± 6.8 vs. 4.7 ± 3.9 days (p < 0.001) for the oncological group, 6.5 ± 6.4 vs. 4.4 ± 3.2 days (p < 0.001) for the gastrointestinal group, and 6.8 ± 5.7 vs. 5.4 ± 5.7 days (p = 0.035) for the cardiovascular group.
Conclusions: Unplanned 30-day readmission rates and length of stay among malnourished hospitalized patients with oncological, gastrointestinal, or cardiovascular diagnoses can be significantly decreased through a comprehensive nutrition-focused QIP. These results highlight the importance of nutrition screening, education, and treatment of all hospitalized patients, and in particular the ones admitted for oncological, gastrointestinal, or cardiovascular complications.