Hospital admissions for congestive heart failure (CHF) are a major driver of costs for health systems, and CHF is especially prevalent in patients aged 65 and older. This study assessed whether provision of oral nutritional supplements (ONS) in the hospital can reduce these costs, by estimating the effect of ONS use on 30-day readmission rates, length of stay (LOS), and hospitalization episode costs.
Using the 2000-2010 Premier Research database, a large US hospital episode database, we extracted a sample of episodes among patients aged 65 and older with a primary diagnosis of CHF. We excluded episodes involving tube feeding and those ending in death (due to censoring). Using propensity score matching, we created a 1: 1 matched sample of ONS and non-ONS episodes. We applied ordinary least squares (OLS) and instrumental variables (IV) regression analyses to investigate the outcomes of ONS use. The key outcomes studied were 30-day readmission rates, LOS, and episode costs (measured in 2010 US$).
Propensity score matching produced a matched sample of 38,418 CHF episodes. Naïve OLS analysis, which did not account for selection bias, suggested that ONS increased costs, LOS, and probability of 30-day readmission. However, using IV regression analysis to control for selection bias revealed that ONS use reduced the probability of readmission within 30 days by 10.1%, from 0.387 to 0.360 (p<0.01). LOS was reduced through ONS use by 1.28 days (14.2%), from 9.03 to 7.75 (p<0.01). Episode costs were significantly lower with ONS use, reducing medical expenditures by $1,266 (7.8%), from $16,166 to $14,900 (p<0.01).
In elderly patients hospitalized with CHF, ONS improves 30-day readmission, LOS, and episode cost outcomes. ONS use could provide a low-cost strategy for improving hospitalization outcomes for elderly patients with CHF and reducing burden on health systems from CHF.
© 2014 Published by Elsevier Inc.