A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition

JPEN J Parenter Enteral Nutr. 2013 Nov;37(6):796-801. doi: 10.1177/0148607113492337. Epub 2013 Aug 22.


Healthcare spending in the United States is the highest in the world, yet quality indicators such as life expectancy and infant mortality lag other countries. U.S. reforms are under way to lower costs and raise quality of care, notably the Patient Protection and Affordable Care Act (PPACA). Value-based purchasing (VBP) and programs for reducing the incidence of hospital-acquired conditions (HACs) and hospital readmissions represent initial changes. With these programs, overarching themes are to coordinate care during and beyond hospitalization and to ensure that physicians and hospitals are aligned in their treatment strategies. Hospital malnutrition represents a large, hidden, and costly component of medical care; hospital administrators and caregivers alike must harness the benefits of nutrition as a vital component of healthcare. Medical, nursing, and allied health training programs must find places in their curricula to increase awareness of nutrition and promote knowledge of best-practice nutrition interventions. Hospitals use dietitians and nutrition support teams as critical members of the patient care team, but more work needs to be done to disseminate and enforce best nutrition practices. Such training, nutrition interventions, and practice changes can help prevent and treat malnutrition and thus help avert HACs, reduce hospital readmissions, lower infection and complication rates, and shorten hospital stays. Nutrition care is an effective way to reduce costs and improve patient outcomes. This article calls hospital executives and bedside clinicians to action: recognize the value of nutrition care before, during, and after hospitalization, as well as develop training programs and policies that promote nutrition care.

Keywords: healthcare costs; hospital readmissions; hospital-acquired conditions; malnutrition.

Publication types

  • Review

MeSH terms

  • Cross Infection / prevention & control
  • Delivery of Health Care / standards*
  • Health Care Costs
  • Health Services Needs and Demand*
  • Humans
  • Malnutrition / economics
  • Malnutrition / prevention & control*
  • Nutrition Therapy*
  • Nutritional Status*
  • Nutritional Support*
  • Patient Care Team
  • Patient Readmission* / economics
  • United States