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Introduction
The goal of all health care institutions and
clinicians is to make sick people healthier. In 2001,
the Institute of Medicine (IOM) released a pivotal
report, Crossing the Quality Chasm. According
to the report, the American healthcare delivery
system is in need of fundamental change and
quality problems are everywhere affecting many
patients (1). A 2004 publication cosponsored by
the Office of the Inspector General of the U.S.
Department of Health and Human Services and
the American Health Lawyers Association (2)
discusses the 2001 IOM report, stating that the
oversight of quality and patient safety is a core
financial responsibility of all health care
organizations and that promoting quality care
and patient safety are at the center of the health
care industry. In other words, the goal for all in
health care is to improve patient outcomes.
Improving patient outcomes requires research at
several levels to determine which interventions
are effective for specific patient populations.
Although clinicians must understand molecular
and cellular processes to cure or delay the
progression of disease, they also must determine
whether practical application of that research
results in actual improvement in patient
outcomes. Health care institutions also are vitally
interested in financial management outcomes.
Administrators want to know how to provide the
best care to ensure good patient outcomes
within accepted economic parameters.
Primarily for economic reasons, acute-care
hospitals in the United States focus many of their
institutional goals on areas that are deemed
important by The Centers for Medicare &
Evaluation Steps
The first step in the evaluations cited in the
previous scenarios and others like them is to
recognize a process that needs improvement and
establish the baseline. Before evaluating patient
outcomes after a change in process or nutrition
intervention, clinicians must describe the current
state of affairs, that is, establish the benchmark.
The current patient population should be
evaluated and described quantifiably to establish
baseline benchmarks against which future
improvements can be measured.
In the first scenario, a descriptive study showing the
number of patients discharged on tube feedings
and the percent of these who are readmitted to the
hospital or emergency department (ED) within a
given time frame can help to determine if the
problem is as substantial as the perception based on
experiential observation. For other scenarios,
clinicians can establish benchmarks by participating
in mandatory health care benchmark programs such
as a patient satisfaction program or comparing
conditions such as hospital-acquired pressure ulcer
prevalence against the national benchmark
Example Metrics for Patient Outcome Scenario Example Metrics for Financial Management Scenario
Describe the
current situation
Determine indications
Readmission rates or ED visits in home EN patients
of the need
compared to all patients discharged to home
for improvement
Costs associated with readmissions and ED visits
Determine indications
of success
ENSURE ENLIVE
HMBg
+2O0TEIN
PR
20g 350 26 3g
Protein
Calories
Vitamins &
Minerals
Fiber
Conclusion
References
Abstract
Health care reform and changes in policy have
brought about an increased focus on costs,
quality, and transparency of care (1). In 2013, the
Alliance to Advance Patient Nutrition proposed
a model that redefined clinical roles of the
nutritional professional and proposed an
interdisciplinary approach to better diagnose and
treat malnutrition in hospitalized patients. Both
enteral and parenteral industry partners have
begun to develop programs and partnerships
with health care professionals and national
organizations to support this effort. This has
led to greater demand within the industry for
nutrition professionals who have experience
in clinical, academic, and research settings to
fill positions beyond traditional sales and
commercial roles. The Accreditation Council for
Continuing Medical Education (ACCME) has
released specific standards for collaboration with
for-profit organizations that support continuing
medical education activities. The ACCME also
developed standards for clinicians who work in
for-profit organizations (2). This article reviews
the experiences of two nutrition support
professionals who work in industry and provides
a general overview of the areas in which clinical
nutrition expertise can be of significant value
outside of clinical venues.