BACKGROUND: COPD is a leading cause of death and disability in the United States. (8.7 days vs 6.9 days, < .0001), higher hospitalization cost ($14,223 vs $9,340, < .0001), and lower readmission rates (24.8% vs 26.6%, = .0116). However, in instrumental buy GSK-923295 variables analysis, ONS use was associated with a 1.9-day (21.5%) decrease in LOS, from 8.8 to 6.9 days (< .01); a hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (< .01); and a 13.1% decrease in probability of 30-day readmission, from 0.34 to 0.29 (< .01). CONCLUSIONS: ONS may be associated with reduced LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD. COPD is a leading cause of morbidity and mortality, with 14.8 million prevalent diagnosed cases in the United States.1 COPD is associated with progressive declines in respiratory function, mediated in part through frequent acute exacerbations as the disease worsens.2,3 Declining respiratory function, in turn, leads to increased mortality risk,4,5 reduced quality of life,6\8 and greater risk of disability.2,5,9,10 COPD also imposes a substantial economic burden. In 2010 2010, for example, the cost of COPD in the United States was estimated at nearly $50 billion annually.2,11 Because of its typical onset later in life and its progressive nature, 2 COPD imposes particularly large costs on Medicare. Compared with age- and sex-matched counterparts without COPD, Medicare patients with COPD incurred approximately $20,500 (26.0%) more in health-care costs in 2004.12 In response to the growing prevalence of and large costs associated with COPD, Medicare is implementing new hospital quality targets designed specifically to measure and improve the quality of care provided to patients with COPD.13 These targets include a mandate, beginning in 2015, to reduce preventable readmissions among patients with COPD. Under the mandate, hospitals with readmission rates above a risk-adjusted target will be required to pay penalties for the excess readmissions.13,14 Given these quality initiatives and the fixed payments hospitals receive for the management of patients admitted with exacerbations of COPD, providers must find new, cost-effective strategies to improve the quality of hospital care for patients with COPD. To date, much of the management of patients hospitalized with COPD has focused on the Rabbit Polyclonal to HBP1 appropriate use of nebulized bronchodilators, systemic corticosteroids, supplemental oxygen, and antibiotics.2,15,16 However, these management strategies neglect an important comorbidity of patients hospitalized with COPD: nutritional deficiency. Nutritional deficiency and negative energy balance are common among patients hospitalized with COPD, particularly during acute exacerbations,17\19 and have been associated with poor prognoses.20\22 Not surprisingly, growing evidence suggests that nutritional interventions such as vitamin D repletion,23,24 dietary fiber,25,26 and oral nutritional supplementation (ONS)27\29 are associated with improved outcomes for patients with COPD on a variety of dimensions. In particular, ONS use is associated with improvements in weight gain, lean body mass, muscle strength, 6-min walking distance, and ability to exercise in patients with COPD.28 Despite the importance of nutritional support in patients with COPD, however, current guidelines do not include specific recommendations for addressing nutritional deficiencies in this population.16 Also, in addition to the clinical benefits to patients with COPD, nutritional support through ONS in other disease states has been associated with reduced costs,30\34 length of stay (LOS),27,35,36 and readmission rates among hospitalized patients.35\37 Despite the effects of nutritional deficiencies on morbidity and mortality buy GSK-923295 in patients with COPD and the large burden of COPD-related costs to Medicare, limited evidence exists on the association between hospital use of ONS and outcomes of Medicare patients hospitalized with COPD. To address this issue, we examined the association between hospital ONS use and LOS, hospitalization cost, and 30-day readmission in Medicare patients aged 65 years hospitalized with COPD. Materials and Methods Data Source The study sample was obtained from the Premier Research Database, which buy GSK-923295 contains deidentified diagnostic information and billing records from 46 million hospitalizations in 460 hospitals from 2000 to 2010. Estimated to cover 20% of all US hospitalizations, the Premier database includes data from mostly small to midsized hospitals serving primarily urban populations in 41 states, representing all regions of the United States, and it is considered to be representative folks.