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Nutritional follow-up after discharge prevents readmission to hospital - A randomized clinical trial

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The journal of nutrition, health & aging

Abstract

Objective

To compare the effects of two individualized nutritional follow-up intervention strategies (home visit or telephone consultation) with no follow-up, with regard to acute readmissions to hospital at two points in time, 30 and 90 days after discharge from hospital.

Design

Randomized clinical trial with two intervention groups and one control group, and monitoring on readmission at 30 and 90 days after discharge.

Setting

Intervention in the participants’ homes after discharge from hospital.

Participants

Inclusion: Malnourished geriatric patients and patients at risk of malnutrition (MNA<24), aged 75 years and older, living at home and alone. Exclusion: Nursing home residents and patients with terminal illnesses or cognitive impairment. Randomization: Upon discharge, the patients were stratified according to nutritional status (MNA), and assigned to one of three groups: ‘home visit’, ‘telephone’, or ‘control’ group. Intervention: Individualized nutritional counselling of the patient and the patient’s daily home carer by a clinical dietician one, two, and four weeks after discharge from hospital. The counselling was either in-person at the patient’s homes, or over the telephone. All patients received a diet plan on discharge. The control group received standard care, but no follow-up after discharge.

Measurements

Information on readmissions to hospital and mortality at 30 and 90 days after discharge was obtained from electronic patient records. Intention-to-treat (ITT) and per-protocol (PP) analyses were carried out.

Results

Two-hundred and eight participants were randomized, 73 to home visits, 68 to the telephone consultation group, and 67 to the control group. The mean age of the participants was 86.1 years. Home visit participants had a lower risk of readmission to hospital compared to control participants at 30 days after discharge (HR=0.4; 95% CI: 0.2-0.9, p=0.03) and 90 days after discharge (HR=0.4; 95% CI: 0.2-0.8, p<0.01). No significant difference was detected between the telephone consultation group and the control group, at either 30 days (HR=0.6, 95% CI: 0.3-1.3, p=0.18) or 90 days after discharge (HR=0.7, 95% CI: 0.4-1.3, p=0.23). The PP analysis revealed that the risk of readmission was significantly lower in the home visit group compared to the control group and the telephone consultation group compared to the control group, and this was evident at 30 days as well as at 90 days after discharge.

Conclusion

An individualized nutritional follow-up performed as home visits seems to reduce readmission to hospital 30 and 90 days after discharge. Intervention by telephone consultations may also prevent readmission, but only among participants who receive the full intervention.

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Authors and Affiliations

  1. Aarhus University Hospital, Geriatrics, P.P. Oerumsgade 11, Aarhus, 8000, Denmark

    Jette Lindegaard Pedersen, P. U. Pedersen & E. M. Damsgaard

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  1. Jette Lindegaard Pedersen
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  2. P. U. Pedersen
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  3. E. M. Damsgaard
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Correspondence to Jette Lindegaard Pedersen.

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Lindegaard Pedersen, J., Pedersen, P.U. & Damsgaard, E.M. Nutritional follow-up after discharge prevents readmission to hospital - A randomized clinical trial. J Nutr Health Aging 21, 75–82 (2017). https://doi.org/10.1007/s12603-016-0745-7

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  • DOI: https://doi.org/10.1007/s12603-016-0745-7

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