Outcome Indicators for Home Parenteral Nutrition Care: Point of View From Adult Patients With Benign Disease

JPEN J Parenter Enteral Nutr. 2015 Sep;39(7):828-36. doi: 10.1177/0148607114536926. Epub 2014 Jun 10.

Abstract

Background and aims: Patients receiving home parenteral nutrition (HPN) deserve a high-quality and patient-centered care. Patient-centered care can be delivered only if the patient's priorities and concerns are known. Therefore, the aim is to identify the top 3 most important outcome indicators according to patients' perspectives and the differences between several centers, HPN regimen, and HPN experience.

Methods: A questionnaire, based on previously developed outcome indicators, was translated into the mother tongue using forward-backward translation and distributed to adult HPN patients with benign disease in March 2013. To identify differences, a Kruskal-Wallis or Mann-Whitney test was performed with GraphPad Prism (significance level <.05) when applicable.

Results: Nine centers over 8 countries (300 patients) participated. The top 3 outcome indicators for patients were (1) incidence of catheter-related infection (CRI), (2) survival, and (3) quality of life (QoL). Between the participating centers, significant differences on rating were found for 5 outcome indicators (catheter obstruction, .015; weight, .002; energy, .010; fear, <.001; and independence, .010). The independence outcome indicator (.050) was considered less important for experienced (>2 years HPN) vs less experienced patients. For this outcome indicator, patients' view also differed significantly based on number of HPN days per week (.0103).

Conclusion: A cohort of HPN patients identified incidence of CRI, survival, and QoL as the most important outcome indicators for their care; however, there were significant differences between the participating centers. For one outcome indicator (independence), there were significant differences based on experience and regimen.

Keywords: home nutrition support; long-term care; nutrition; nutrition support practice; outcomes research/quality.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Catheter-Related Infections / epidemiology*
  • Catheter-Related Infections / etiology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Parenteral Nutrition, Home / adverse effects*
  • Patient-Centered Care / methods
  • Quality of Life
  • Surveys and Questionnaires
  • Treatment Outcome
  • Young Adult