Improved Patient Outcomes, Reduced Hospital Costs With Early Dysphagia Diagnosis

Nestle Health Science Urges Systematic Screening to Help Improve Outcomes, Decrease Costs

FLORHAM PARK, N.J., Feb. 22, 2012 /PRNewswire-USNewswire/ -- It is estimated that up to 75 percent of people experiencing dysphagia – the inability or difficulty to safely swallow – go undiagnosed.(1) Systematic screening for dysphagia and early intervention with swallowing therapy and modified diet, as appropriate, can help to reduce pneumonia cases by an average of 87 percent and decrease length of stay by an average of two days.(2,3) Nestle Health Science calls on the medical community to integrate systematic dysphagia screening with the clinically-validated Swallowing Assessment Tool (EAT-10) to identify those at risk for further evaluation.

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Dysphagia affects nearly 25 million people.(4,5) While dysphagia is a condition that can affect individuals at any age, it is most common in adults 65 years and older and individuals diagnosed with head and neck cancers, stroke, brain trauma, cerebral palsy, Parkinson's, Alzheimer's and Huntington's diseases.(6,7)

Up to 89 percent of patients with aspiration pneumonia, a major cause of morbidity and mortality among hospitalized elderly, have dysphagia. Aspiration pneumonia can develop due to the entry of food or liquid into the lungs.(8,9) Undiagnosed dysphagia, resulting in aspiration pneumonia, can cost medical institutions an estimated $4,300 per day, per patient.(10)

"As medical institutions grapple with the impact of the Healthcare Reform Law of 2010, now is the time to identify and implement quality measures that can benefit patient outcomes and potentially reduce the cost of medical care," stated Dr. Juan Ochoa, U.S. medical and scientific director, Nestle Health Science. "Beginning in 2013, Medicare will use mortality and 30-day readmission rates associated with pneumonia as a measure of hospital quality care which will influence reimbursement."

Nestle Health Science recommends a two-step approach to identify dysphagia patients and help improve outcomes by simply implementing the EAT-10 swallowing assessment tool into standard care and referring patients at risk to a speech language pathologist and/or physician for further evaluation and treatment, as needed.

The EAT-10 Swallowing Assessment Tool contains 10 questions designed to identify individuals with swallowing difficulties. The tool does not address treatment, as the objective is merely to identify those at risk so clinicians can intervene early with a tailored therapy and treatment plan.

"Instituting dysphagia screening is essential to determining an appropriate plan of care to improve patient outcomes and mitigate the potential economic impact of prolonged hospitalization," stated Kenneth Altman, MD, Ph.D., associate professor of otolaryngology, Mount Sinai School of Medicine.

"Hospital management is certainly complex, but implementing a validated screening protocol for patients at risk for dysphagia is not," stated Dr. Juan Ochoa. "Evidence-based studies overwhelmingly concur that this simple change can lead to early diagnosis and intervention to help dramatically improve patient outcomes and quality of life, while decreasing costs."

About the Swallowing Assessment Tool (EAT-10)
Designed by a multidisciplinary group of experts and available through Nestle Nutrition Institute, the Swallowing Assessment Tool is a clinically-validated tool utilized to identify individuals who may be at risk of dysphagia and should receive further evaluation.

The EAT-10 is a symptom-specific survey instrument for dysphagia. It is specifically developed to assess dysphagia symptom severity. This assessment tool can be completed in two minutes by answering 10 questions.

The EAT-10 Tool can be accessed at: http://www.nestlenutrition-institute.org/Documents/test1.pdf.

About Nestle Health Science
Nestle Health Science offers nutritional solutions for people with specific dietary needs related to illnesses, disease states or the special challenges of different life stages. Nestle Health Science, a wholly owned subsidiary of Nestle S.A., became operational on January 1, 2011 and has worldwide headquarters in Lutry, Switzerland. For more information, visit www.nestlehealthscience.com.

1. Kayser-Jones J. Pengilly K. Dysphagia among nursing home residents. Geriatr Nurs. 1999;20:77-82.
2. Doggett DL, Tappe KA, Mitchell MD, et al. Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature. Dysphagia. 2001 Fall;16(4):279-95.
3. Odderson IR et al. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil. 1995;12:1130-3.
4. United Nations, Department of Economic and Social Affairs. World population prospects, the 2010 revision. http://esa.un.org/unpd/wpp/Excel-Data/DB02_Stock_Indicators/WPP2010_DB2_F01_TOTAL_POPULATION_BOTH_SEXES.XLS. Updated October 31, 2011. Accessed November 21, 2011.
5. Mold JW et al. Prevalence of gastroesophageal reflux in elderly patients in a primary care setting. Am J Gastroenterol. 1991;86:965–970.
6. U.S. National Library of Medicine, National Institutes for Health. Swallowing disorders. http://www.nlm.nih.gov/medlineplus/swallowingdisorders.html. Accessed February 13, 2012.
7. Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1 Suppl):154S-68S.
8. Langmore SE et al. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998;13:69-81.
9. Martin BJ et al. The association of swallowing dysfunction and aspiration pneumonia. Dysphagia. 1994;9:1-6.
10. Estimated patient cost per day is derived from average hospital costs associated with pneumonia from the 2008 HCUP database.  Nestle Healthcare Nutrition. Data on file.

SOURCE Nestle Health Science