The use of a Multi-morbidity Index (MMI) in Patients Receiving Home Parenteral Nutrition (HPN)

BackgroundHome Parenteral Nutrition (HPN) patients often have multiple concomitant medical conditions. A validated multi-morbidity index (MMI) could help determine risks and need of HPN patients. We applied an MMI analysis in a Quality Improvement Project for HPN (QIP-PN) to determine if MMI scoring predicted outcomes. Materials and MethodsData from 60 HPN patients were analyzed for Cumulative Illness Rating Scale (CIRS) score, PN formula changes, hospitalizations and hospital length of stay (LOS). Density plots were produced to select CIRS score cutoff values. A correlation matrix was drawn showing Spearman correlations among the three variables of interest. The data were then subjected to Kruskal-Wallis and Wilcoxon Rank Sum Tests and Negative Binomial Regression Models to determine if the groups differed significantly. ResultsCIRS scores ranged from 9-25 (mean = 17.0 {+/-} 3.85). There were 367 PN formula changes for patients with CIRS [&ge;]17, compared to 297 with CIRS <17. There were 19 hospitalizations for patients with CIRS [&ge;]17 (n=19), compared to 10 with CIRS <17. Total hospital LOS was 122 days for patients with CIRS [&ge;]17 (3.8 days/patient) compared to 100 with CIRS <17 (3.57 days/patient). Results of negative binomial regression indicate that the total hospital LOS was significantly higher in patients with a CIRS [&ge;]17 than CIRS<17 at 5% alpha level. ConclusionCIRS methodology was well suited for HPN patients. CIRS data on long term HPN patients produced a trend wherein higher multi-morbidity scores were associated with greater hospital LOS. This approach requires further study and validation. Key Messages BoxO_LIWhat is already known on this topic? The risk of HPN complications is known to relate to patient demographics, length of functional bowel, duration of HPN therapy and macronutrient content. A validated method for determining multi-morbidity in HPN patients may be beneficial in determining the needs of and risk for each HPN patient. C_LIO_LIWhat does this study add? The study explores the role of measuring multi-morbidity scoring in HPN care to determine the risk of adverse effects during therapy. We found a correlation between multi-morbidity and greater length of stay when HPN patients are readmitted to the hospital. If confirmed, such a correlation could help providers determine how to allocate resources during HPN care. C_LIO_LIHow might this study affect research, practice or policy? The study suggests that using validated multi-morbidity index for HPN patients could help healthcare providers and payors allocate resources based on risk analysis. C_LI