CURRENT USE AND CLINICAL OUTCOME OF HOME PARENTERAL AND ENTERAL NUTRITION THERAPIES IN THE UNITED-STATES

Background and Aims: Home nutrition support, especially when delivered parenterally, is very costly. The aim of this study is to examine cur rent usage of home parenteral and enteral nutrition (HPEN) in the Unit ed States and the quality of therapy outcome. Methods: Medicare HPEN u se from 1989 to 1992 was analyzed to assess use, growth, and costs. Na tional Registry information collected on 9288 patients treated with HP EN from 1985 to 1992 was used to assess disease distribution and thera py outcome. Results: In the United States, there were approximately 40 ,000 parenteral and 152,000 enteral home patients in 1992. The usage o f HPEN doubled between 1989 and 1992, and a large proportion was in pa tients with short survival. The prevalence of HPEN in the United State s was 4-10 times higher than in other Western countries. Outcome data showed both therapies were relatively safe. The primary disease strong ly influenced survival and rehabilitation, and age, per se, was not a reason to deny HPEN. Conclusions: Predicted quality survival at home f or several months, rather than a specific diagnosis, seems to be the s oundest justification for HPEN. Its role in terminal conditions and pa tients without primary gastrointestinal diseases needs further evaluat ion.