The ONSHUG Survey : A Quality Care Programme

Oral Nutritive Supplements : Indications, Prescription and Follow-up for Hospitalized and Out-patients at Nutritional Risk or With Malnutrition. A Quality Care Programme at the Geneva University Hospital : The ONSHUG Survey

Hypothesis : At hospital discharge for home, the medical prescription of ONS according to the official criteria of SSNC and the legal regulations (completed prescription according to health's insurance and homecare delivery) dictates the compliance of the patient and the reimbursement of the ONS.

Study Overview

• Status: Completed
• Conditions: Undernutrition
• Intervention / Treatment: Dietary supplement: Oral nutritive supplements

Detailed Description

Rationale : At hospital admission, patients with an acute or chronically impaired nutritional balance are at nutritional risk. These patients can be identified by the Nutritional Risk Score 2002 (NRS 2002). Oral Nutritive Supplements (ONS) represent the first line of nutrition intervention. ONS are frequently prescribed during the hospital stay, and should be continued or discontinued after the hospital discharge. This latter decision should be based on officials criteria, defined by the Swiss Society for Clinical Nutrition (SSNC). To allow ONS reimbursement according to the legal regulations, all required administrative actions should be completed at the time of ONS prescription until the end of the treatment.

Center : Geneva University Hospital (HUG), site of Cluse-Roseraie.

Design : Quality control prospective observational survey.

Population : Hospitalized adults patients with Oral Nutritive Supplements (ONS). Four hundred patients to be included.

Duration : Inclusion from April to December 2015 (9 months).

Hypothesis : At hospital discharge for home, the medical prescription of ONS according to the official criteria of SSNC and the legal regulations (completed prescription according to health's insurance and homecare delivery) dictates the compliance of the patient and the reimbursement of the ONS.

Aims : The primary aim is to document the existence of an ONS medical prescription during the hospitalization and at hospital discharge for home.

The secondary aims are to describe :

• NRS 2002 score when prescribing ONS during the hospitalization, at hospital discharge for home and one month after hospital discharge for home
• Indications for ONS prescription at hospital discharge for home according to the official criteria of SSNC
• Type of ONS prescription at hospital discharge for home
• Number of ONS consumed one month after hospital discharge compared to prescription at hospital discharge
• Timing of the discontinuation of the ONS treatment
• Reasons for stopping the ONS intake.

Methods : Included are all hospitalized adults patients with ONS prescription at the HUG. Excluded are patients with ONS delivery by a homecare before the admission at the HUG or patients refusing to consume ONS or patients with major disorders of consciousness (ex : dementia) or patients unable to consume ONS (ex : dysphagia, dysfunction of upper limbs, etc.) or patients refusing to participate to the survey.

At inclusion, the comorbidities will be assessed by the Charlson Comorbidity Index. ONS prescription and nutritional risk by the NRS 2002 score will be described at hospital and at hospital discharge for home. One month after hospital discharge for home, patient's compliance to ONS will be assessed as nutritional risk by the NRS 2002 score.

Statistics : Data will be presented as mean ± standard deviation or as numbers and percentages according to the relevance, and analyzed using Chi-squared test or unpaired t-test as required.

• Study Type: Observational
• Enrollment (Actual): 416

Contacts and Locations

Study Locations

• Switzerland
  • Geneva, Switzerland, 1211
    • Geneva University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Hospitalized adults patients with Oral Nutritive Supplements in medical and surgical wards of the Geneva University Hospital, site of Cluse-Roseraie

Description

Inclusion Criteria:

• Age > 18 years
• Hospitalization in medical and surgical wards of the Geneva University Hospital, site of Cluse-Roseraie
• Oral nutritive supplements prescription during hospitalization

Exclusion Criteria:

• Oral nutritive supplements delivery by a homecare before the admission in Geneva University Hospital wards, site of Cluse-Roseraie
• Patient refusal to consume oral nutritive supplements
• Major disorders of consciousness (ex : dementia)
• Physical impossibility to consume Oral nutritive supplements (ex : dysphagia, dysfunction of upper limbs, etc.)
• Patient refusal to participate to the survey

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Oral Nutritive Supplements medical prescription	Change between prescription at hospital and prescription at hospital discharge (an expected average of 6 days after admission)

Secondary Outcome Measures

Outcome Measure	Time Frame
NRS 2002 score assessed by questionnaire	Change between score at oral nutritive supplements prescription at hospital and score at hospital discharge for home (an expected average of 6 days after admission) and score one month after hospital discharge for home
Indications for oral nutritive supplements prescription according to the official criteria of SSNC	At hospital discharge for home (an expected average of 6 days after admission)
Number of oral nutritive supplements consumed compared to prescription at hospital discharge	One month after hospital discharge
Timing for stopping the oral nutritive supplements intake if stopped	One month after hospital discharge
Reasons for stopping the oral nutritive supplements intake if stopped	One month after hospital discharge

Collaborators and Investigators

• Sponsor: University Hospital, Geneva
• Investigators: Principal Investigator: Claude Pichard, MD, PhD, University Hospital, Geneva

Publications and helpful links

General Publications

• Mareschal J, Altwegg J, Berthet D, Chikhi M, Chopard P, Graf S, Sierro C, Pichard C, Genton L. Prescription and indication for oral nutritional supplements in a Swiss university hospital: a prospective survey. Swiss Med Wkly. 2017 Aug 3;147:w14475. doi: 10.4414/smw.2017.14475. eCollection 2017.

Study record dates

Study Major Dates

• Study Start: May 1, 2015
• Primary Completion (ACTUAL): October 1, 2016
• Study Completion (ACTUAL): December 1, 2016

Study Registration Dates

• First Submitted: June 1, 2015
• First Submitted That Met QC Criteria: June 16, 2015
• First Posted (ESTIMATE): June 19, 2015

Study Record Updates

• Last Update Posted (ESTIMATE): January 23, 2017
• Last Update Submitted That Met QC Criteria: January 20, 2017
• Last Verified: January 1, 2017

More Information

Terms related to this study

• Keywords: Homecare; Oral nutritive supplements; Nutritional risk screening
• Additional Relevant MeSH Terms: Nutrition Disorders; Malnutrition
• Other Study ID Numbers: Quality program ONSHUG 2015-04