Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition
Introduction Home parenteral nutrition (HPN) is essential for patients with intestinal failure requiring long-term nutritional support. The Amerita Quality Improvement Project for HPN Patients (QIP-PN) explored the effect of a physician nutrition expert (PNE)-led multidisciplinary nutritional suppor...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
|
| Series: | BMJ Nutrition, Prevention & Health |
| Online Access: | https://nutrition.bmj.com/content/early/2022/11/15/bmjnph-2022-000484.full |
| _version_ | 1798017697344126976 |
|---|---|
| author | Rebecca Brown Michael Rothkopf Mohan Pant Jaimie Haselhorst Francine Gagliardotto Allison Tallman Debbie Stevenson Andrew DePalma Michael Saracco Dan Rosenberg Vladimir Proudan Kishwar Shareef Nudrat Ayub |
| author_facet | Rebecca Brown Michael Rothkopf Mohan Pant Jaimie Haselhorst Francine Gagliardotto Allison Tallman Debbie Stevenson Andrew DePalma Michael Saracco Dan Rosenberg Vladimir Proudan Kishwar Shareef Nudrat Ayub |
| author_sort | Rebecca Brown |
| collection | DOAJ |
| description | Introduction Home parenteral nutrition (HPN) is essential for patients with intestinal failure requiring long-term nutritional support. The Amerita Quality Improvement Project for HPN Patients (QIP-PN) explored the effect of a physician nutrition expert (PNE)-led multidisciplinary nutritional support team (MNST) on HPN care for patients under its service.Objective To determine an MNST effect on adherence to protocols, outcomes and quality of life (QOL) in HPN.Methods The study was divided into three phases: data review (phases 1a and 1b), observation (phase 2) and intervention (phase 3). Seven Amerita locations were selected as ‘study branches’ (population), from which all study patients and controls were drawn. The quality improvement project employed a quasi-experimental case-matched control group (control) design. Data were collected on demographics, treating physicians PNE status, HPN care variables, recommended interventions, quality-of-life assessment, adverse outcomes and hospitalisations. Paired t-test compared continuous data between phases 2 and 3. Comparisons between study and control groups used a negative binomial regression model.Results Thirty-four patients were reviewed in phase 1a and 197 in phase 1b. Forty study patients completed phase 2 and progressed into phase 3, of whom 30 completed ≥60 therapy days. Patients were lost to follow-up if they discontinued HPN for any reason. Improvements in weight, body mass index and QOL were seen in the study patients during intervention. Recommendations made and accepted by treating physicians differed based on PNE status. Study patients had fewer adverse outcomes and related hospitalisations than controls.Conclusion MNST recommendations improved clinical, biochemical parameters and patients’ self-reported overall health. MNST input reduced adverse outcomes, hospitalisation and the length of stay at the hospital. This study highlights the potential for MNST to have a significant impact on the quality and overall cost of HPN management. |
| first_indexed | 2024-04-11T16:11:36Z |
| format | Article |
| id | doaj.art-22a74f8ac1c14935804158520f180dc2 |
| institution | Directory Open Access Journal |
| issn | 2516-5542 |
| language | English |
| last_indexed | 2024-04-11T16:11:36Z |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Nutrition, Prevention & Health |
| spelling | doaj.art-22a74f8ac1c14935804158520f180dc22022-12-22T04:14:39ZengBMJ Publishing GroupBMJ Nutrition, Prevention & Health2516-554210.1136/bmjnph-2022-000484Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutritionRebecca Brown0Michael Rothkopf1Mohan Pant2Jaimie Haselhorst3Francine Gagliardotto4Allison Tallman5Debbie Stevenson6Andrew DePalma7Michael Saracco8Dan Rosenberg9Vladimir Proudan10Kishwar Shareef11Nudrat Ayub12Amerita, Inc, Denver, Colorado, USADepartment of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USASchool of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, USAAmerita, Inc, Denver, Colorado, USAAmerita, Inc, Denver, Colorado, USAAmerita, Inc, Denver, Colorado, USAAmerita, Inc, Denver, Colorado, USAAmerita, Inc, Denver, Colorado, USASea Meadows, LLC, Brick, NJ, USAAmerita, Inc, Denver, Colorado, USAAtlantic Health System Inc, Florham Park, New Jersey, USAAtlantic Health System Inc, Florham Park, New Jersey, USAAtlantic Health System Inc, Florham Park, New Jersey, USAIntroduction Home parenteral nutrition (HPN) is essential for patients with intestinal failure requiring long-term nutritional support. The Amerita Quality Improvement Project for HPN Patients (QIP-PN) explored the effect of a physician nutrition expert (PNE)-led multidisciplinary nutritional support team (MNST) on HPN care for patients under its service.Objective To determine an MNST effect on adherence to protocols, outcomes and quality of life (QOL) in HPN.Methods The study was divided into three phases: data review (phases 1a and 1b), observation (phase 2) and intervention (phase 3). Seven Amerita locations were selected as ‘study branches’ (population), from which all study patients and controls were drawn. The quality improvement project employed a quasi-experimental case-matched control group (control) design. Data were collected on demographics, treating physicians PNE status, HPN care variables, recommended interventions, quality-of-life assessment, adverse outcomes and hospitalisations. Paired t-test compared continuous data between phases 2 and 3. Comparisons between study and control groups used a negative binomial regression model.Results Thirty-four patients were reviewed in phase 1a and 197 in phase 1b. Forty study patients completed phase 2 and progressed into phase 3, of whom 30 completed ≥60 therapy days. Patients were lost to follow-up if they discontinued HPN for any reason. Improvements in weight, body mass index and QOL were seen in the study patients during intervention. Recommendations made and accepted by treating physicians differed based on PNE status. Study patients had fewer adverse outcomes and related hospitalisations than controls.Conclusion MNST recommendations improved clinical, biochemical parameters and patients’ self-reported overall health. MNST input reduced adverse outcomes, hospitalisation and the length of stay at the hospital. This study highlights the potential for MNST to have a significant impact on the quality and overall cost of HPN management.https://nutrition.bmj.com/content/early/2022/11/15/bmjnph-2022-000484.full |
| spellingShingle | Rebecca Brown Michael Rothkopf Mohan Pant Jaimie Haselhorst Francine Gagliardotto Allison Tallman Debbie Stevenson Andrew DePalma Michael Saracco Dan Rosenberg Vladimir Proudan Kishwar Shareef Nudrat Ayub Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition BMJ Nutrition, Prevention & Health |
| title | Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition |
| title_full | Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition |
| title_fullStr | Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition |
| title_full_unstemmed | Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition |
| title_short | Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition |
| title_sort | impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition |
| url | https://nutrition.bmj.com/content/early/2022/11/15/bmjnph-2022-000484.full |
| work_keys_str_mv | AT rebeccabrown impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT michaelrothkopf impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT mohanpant impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT jaimiehaselhorst impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT francinegagliardotto impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT allisontallman impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT debbiestevenson impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT andrewdepalma impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT michaelsaracco impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT danrosenberg impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT vladimirproudan impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT kishwarshareef impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition AT nudratayub impactofamultidisciplinarynutritionalsupportteamonqualityimprovementforpatientsreceivinghomeparenteralnutrition |