Clinical nutrition ESPEN · 2025
Economic consequences when enteral tube feeding intolerance causes unplanned discontinuation in hospitalized older patients with gastroesophageal reflux disease.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Kamada Yukikazu, Kawano Kanako, Iguchi Akina, Tominaga Noriko, Okamoto Chisato, Inoue Masatoshi, Igarashi Ataru, Kitakaze Masafumi
Аннотация
BACKGROUND & AIMS: Enteral tube feeding intolerance (ETFI) is a common complication in older patients with gastroesophageal reflux disease (GERD), often leading to unplanned discontinuation of nutritional support. While the clinical consequences of ETFI are well-documented, its economic impact on hospital operations remains unclear. This study aimed to evaluate the financial consequences of ETFI-related discontinuation of enteral nutrition in hospitalized older patients with GERD, focusing on changes in medical resource allocation and hospital revenue under Japan's hybrid reimbursement system.
METHODS: A retrospective observational study was conducted using patient-level data from a long-term care ward in Japan between April 2018 and March 2021. Patients who initiated enteral tube feeding were categorized based on whether enteral feeding was discontinued due to intolerance. Medical claims data were analyzed to calculate fee-for-service (FFS) and fixed payment system (FPS) charges, unreimbursed medical charges (i.e., revenue loss under FPS), and inpatient living care expenses. Hospital loss simulations were performed based on discontinuation rates and patient characteristics.
RESULTS: Among 149 patients, 23.5 % experienced ETFI-related discontinuation. These patients had significantly lower BMI and shorter feeding durations. Discontinuation was associated with increased unreimbursed medical charges (median JPY +2288/day (USD +15.2/day, USD 1.0 = JPY 150.80) at 1 week post-discontinuation) and decreased living care revenue (median JPY -1179/day (USD -7.82/day)). Multivariate analysis identified ETFI and low BMI (<17.4) as independent predictors of increased hospital revenue losses. Simulations estimated a total loss of JPY 248,000 (USD 1644.56) per 10 hospitalized older patients with GERD over 4 weeks, with greater losses observed in low-BMI patients and those receiving polymeric formulas.
CONCLUSION: Unplanned discontinuation of enteral tube feeding due to intolerance in older patients with GERD imposes a substantial economic burden on hospitals, primarily through unreimbursed medical charges and reduced living care revenue. Preventive strategies-such as early nutritional intervention and formula selection-may mitigate these losses and support sustainable hospital management.
METHODS: A retrospective observational study was conducted using patient-level data from a long-term care ward in Japan between April 2018 and March 2021. Patients who initiated enteral tube feeding were categorized based on whether enteral feeding was discontinued due to intolerance. Medical claims data were analyzed to calculate fee-for-service (FFS) and fixed payment system (FPS) charges, unreimbursed medical charges (i.e., revenue loss under FPS), and inpatient living care expenses. Hospital loss simulations were performed based on discontinuation rates and patient characteristics.
RESULTS: Among 149 patients, 23.5 % experienced ETFI-related discontinuation. These patients had significantly lower BMI and shorter feeding durations. Discontinuation was associated with increased unreimbursed medical charges (median JPY +2288/day (USD +15.2/day, USD 1.0 = JPY 150.80) at 1 week post-discontinuation) and decreased living care revenue (median JPY -1179/day (USD -7.82/day)). Multivariate analysis identified ETFI and low BMI (<17.4) as independent predictors of increased hospital revenue losses. Simulations estimated a total loss of JPY 248,000 (USD 1644.56) per 10 hospitalized older patients with GERD over 4 weeks, with greater losses observed in low-BMI patients and those receiving polymeric formulas.
CONCLUSION: Unplanned discontinuation of enteral tube feeding due to intolerance in older patients with GERD imposes a substantial economic burden on hospitals, primarily through unreimbursed medical charges and reduced living care revenue. Preventive strategies-such as early nutritional intervention and formula selection-may mitigate these losses and support sustainable hospital management.