The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?

Transcription

1 The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?

2 Nestlé Nutrition Institute Workshop Series Clinical & Performance Program, Vol. 12 The Economic, Medical/ Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What? Editors Marinos Elia, Southampton, UK Bruce Bistrian, Boston, MA, USA

3 Nestec Ltd., 55 Avenue Nestlé, CH 1800 Vevey (Switzerland) S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Nestec Ltd., Vevey (Switzerland) and S. Karger AG, Basel (Switzerland). All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or recording, or otherwise, without the written permission of the publisher. Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISSN ISBN e-isbn Library of Congress Cataloging-in-Publication Data Nestlé Clinical & Performance Nutrition Workshop (12th : 2007 : Peebles, Scotland) The economic, medical/scientific, and regulatory aspects of clinical nutrition practice : what impacts what? / editors, Marinos Elia, Bruce Bistrian. p. ; cm. -- (Nestle Nutrition Institute workshop series. Clinical & performance program ; v. 12) Includes bibliographical references and index. ISBN (hard cover : alk. paper) 1. Malnutrition--Congresses. 2. Nutrition policy--congresses. I. Elia, Marinos. I. Bistrian, Bruce R. II. Nestlé Nutrition Institute. IV. Title. V. Series: Nestlé Nutrition workshop series. Clinical & performance programme; v. 12. [DNLM: 1. Malnutrition--economics--Congresses. 2. Health Policy--Congresses. 3. Malnutrition--prevention & control--congresses. 4. Nutritional Physiological Phenomena--Congresses. 5. Nutritional Requirements--Congresses. 6. Socioeconomic Factors--Congresses. W1 NE228C v / WD 100 N468e 2009] RA645.N87N dc Basel Freiburg Paris London New York Bangalore Bangkok Shanghai Singapore Tokyo Sydney The material contained in this volume was submitted as previously unpublished material, except in the instances in which credit has been given to the source from which some of the illustrative material was derived. Great care has been taken to maintain the accuracy of the information contained in the volume. However, neither Nestec Ltd. nor S. Karger AG can be held responsible for errors or for any consequences arising from the use of the information contained herein.

4 Contents VII XI Foreword Contributors 1 The Magnitude of the Problem of Malnutrition in Europe Kondrup, J.; Sorensen, J.M. (Denmark) 15 Malnutrition in North America: Where Have We Been? Where Are We Going? Jensen, G.L. (USA) 29 The Economics of Malnutrition Elia, M. (UK) 41 The Need for Consistent Criteria for Identifying Malnutrition Hoffer, L.J. (Canada) 53 Enteral Nutrition Reimbursement The Rationale for the Policy: The US Perspective Parver, A.K.; Mutinsky, S.E. (USA) 71 Enteral Nutrition Reimbursement The Rationale for the Policy: The German Perspective Pahne, N. (Germany) 79 Food Modification versus Oral Liquid Nutrition Supplementation Silver, H.J. (USA) 95 Cost-Effectiveness Analysis and Health Policy Torgerson, D.J. (UK) 105 Implementing Nutritional Standards: The Scottish Experience McKinlay, A.W. (UK) 113 Innovative Models for Clinical Nutrition and Financing Van Emelen, J. (Belgium) V

5 Contents 121 ENHA: What is It and What Does It Do? Strategies to Make Malnutrition a Key Priority in EU Health Policy de Man, F. (UK) 127 Brief History of Parenteral and Enteral Nutrition in the Hospital in the USA Bistrian, B.R. (USA) 137 What Went Right? The Story of US Medicare Medical Nutrition Therapy Patrick, S. (USA) 159 Subject Index VI

6 Foreword Malnutrition is an under-recognized problem in hospitalized, home and community patients. It has been identified as an issue for more than 30 years, but has struggled to be recognized as an important issue by healthcare clinicians, administrators and government officials. Recent data show that at least 30% of hospitalized patients are malnourished, with a large majority of the cases unrecognized and untreated. Although awareness of the situation is increasing, there remains a great deal of work that must be done to educate healthcare professionals on the value of nutrition intervention as an integral part of medical therapy. Along with this is the need to educate administrators and regulators of the cost benefits of nutrition care. Recent studies have shown that disease-related malnutrition increases healthcare costs by 30 70%. In the UK it has been demonstrated that the costs for hospital malnutrition are greater than that for obesity. Nutritional interventions, representing only a small cost, may result in substantial absolute savings. It is with these facts that the Nestlé Nutrition Institute organized this 12th Clinical and Performance Workshop with the title The Economic, Medical/ Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What? in Peebles, Scotland. Learnings from this workshop include the need to more clearly define malnutrition. There is a strong need to effectively educate physicians on the importance of nutrition in medical therapy something currently lacking in most medical education. Additional work is needed to define outcomes impacted by nutrition intervention. The results of this work need to be clearly and effectively communicated to both healthcare administrators and government and regulatory officials. The identification, prevention and treatment of malnutrition need to be seen by all as an integral part of medical management, thus should not be excluded from reimbursement programs. VII

7 Foreword We want to thank the chairmen, Prof. Marinos Elia from the University of South Hampton, UK and Prof. Bruce Bistrian from Harvard Medical School, USA both experts in the field of clinical nutrition and the economics of malnutrition for putting together the excellent program of this workshop. We also thank our expert speakers for their valuable contribution. Finally, our thanks go to the team from Nestlé UK for their wonderful organization. Prof. Ferdinand Haschke, MD, PhD Chairman Nestlé Nutrition Institute Vevey, Switzerland Patricia S. Anthony, MS, RD and Dr. Petra Klassen Nestlé Nutrition Institute Vevey, Switzerland VIII

8 12th Nestlé Nutrition Institute Workshop Clinical & Performance Program Peebles, Scotland, March 25 29, 2007

9 Contributors Chairpersons & Speakers Prof. Bruce Bistrian Harvard Medical School Beth Israel Deaconess Medical Center 1 Deaconess Road Boston, MA USA bbistria@bidmc.harvard.edu Mr. Frank de Man European Nutrition for Health Alliance c/o Albert Embankment London SE1 7TJ UK frankdeman@newyield.nl Prof. Marinos Elia Institute of Human Nutrition University of Southampton Southampton General Hospital Mailpoint 113, Tremona Road Southampton SO16 6YD UK elia@soton.ac.uk Prof. L. John Hoffer Lady Davis Institute for Medical Research McGill University 3755 Cote-Ste-Catherine Road Montreal, Que. H3T 1E2 Canada l.hoffer@mcgill.ca Prof. Gordon Jensen Department of Nutritional Sciences Pennsylvania State University 110 Chandlee Lab University Park, PA USA GLJ1@psu.edu Prof. Jens Kondrup Department of Human Nutrition Faculty of Life Sciences University of Copenhagen 30 Rolighedsvej DK 1958 Frederiksberg Denmark jens.kondrup@life.ku.dk Dr. Alastair McKinlay Department of Gastroenterology Aberdeen Royal Infirmary Foresterhill Aberdeen AB25 2ZN UK a.w.mckinlay@arh.grampian. scot.nhs.uk Mr. Norbert Pahne Bundesverband der Hersteller von Lebensmitteln für besondere Ernährungszwecke (Diätverband) e.v. Godesberger Allee DE Bonn Germany pahne@diaetverband.de XI

10 Contributors Mr. Alan Parver Bryan Cave LLP 1155 F Street, NW Washington, DC USA alan.parver@bryancave.com Mrs. Stephanie Patrick American Dietetic Association 1120 Connecticut Avenue NW Suite 480 Washington, DC USA spatrick@eatright.org Prof. David Torgerson Department of Health Sciences University of York Heslington York YO10 5DD UK djt6@york.ac.uk Dr. Jan Van Emelen Independent Health Insurance Fund (MLOZ) Belgium Sint Huybrechtstraat 19 BE 1150 Brussels Belgium jan.vanemelen@mloz.be Dr. Heidi Silver Vanderbilt University School of Medicine st Avenue 514 Medical Arts Building Nashville, TN USA heidi.j.silver@vanderbilt.edu Moderators Prof. Demetre Labadarios Human Sciences Research Council 12th Floor, Plein Park Building Plein Street Cape Town 8001 South Africa dlabadarios@hsrc.ac.za Prof. Miguel León Sanz Hospital 12 de octubre Unidad de Nutrición ES Madrid Spain mleon@h120.es Invited Attendees Dr. Marcia Jandre / Brazil Prof. Li He / China Prof. Zeljko Krznaric / Croatia Mr. Herbert Lochs / Germany Prof. Lycourgos Liaropoulos / Greece Mrs. Maria Skouroliakou / Greece Mr. Avgoustis Tatakis / Greece Dr. Julia Álvares Hernández / Spain Dr. Belén González Fernández / Spain Dr. Juana Maria Rabatz Restrepo / Spain Mrs. Yasemin Khoury / Turkey Mr. Roger Clark / UK Mrs Patricia Howard / UK Mrs. Alexa Scott / UK XII

11 Contributors Nestlé Nutrition Participants Mrs. Sophie Dahl / France Dr. Werner Neubrand / Germany Dr. Mireia Morera / Spain Mrs. Josephina Reyero / Spain Mrs. Patricia Anthony / Switzerland Mrs. Catherine Bailly / Switzerland Mr. Michael Jedwab / Switzerland Mr. Eric Lew / Switzerland Mrs. Grainne Mallon / Switzerland Mr. François Murbach / Switzerland Mrs. Fiona Reich / Switzerland Dr. Claudia Roessle / Switzerland Mrs. Lynne Mincher / UK Mr. Peter Morton / UK Mrs. Fabienne Le Tadic / UK Mrs. JoAnn Read / USA XIII