Clinical Reality and Outcomes of Home Semi-Solid Enteral Nutrition Guidance and Management Using a Medical Claims Database in Japan: A Retrospective Cohort Study

Background/Objectives: The semi-solid enteral nutrition method, in which semi-solid nutrients are administered through a gastrostoma rather than liquid nutrients, is a medical technology for nutritional management developed in Japan. This nutritional method has spread rapidly, and in 2018, the Home Semi-solid Enteral Nutrition Guidance and Management fee was newly established in the payment system for medical services. However, there are few studies evaluating this nutrition method in actual clinical practice. Methods: Using the DeSC medical claims database, we investigated patient characteristics, the number of fee calculations, and the length of hospital stay for all hospitalizations and for pneumonia during and after fee calculation. Results: Home semi-solid enteral nutrition guidance and management was received at least once by 3105 patients (mean age: 79.4 years). Cerebrovascular disease, nervous system disease, dementia, and pneumonia were the most common diseases at the start of guidance and management, and the mean number of sessions received was 7.7. The mean length of stay for any hospitalization was significantly shorter during the guidance and management period than after the last guidance and management session (8.2 vs. 29.1 days). Notably, the mean length of hospital stay for pneumonia was also significantly shorter during the guidance and management period than after the last guidance and management session (3.1 vs. 10.2 days). Conclusions: This study clarified the calculation status of the Home Semi-solid Enteral Nutrition Guidance and Management fee and outcomes of patients who received this guidance and management. These findings suggest that the provision of this guidance and management may be associated with the shorter length of hospital stay. However, because residual confounding cannot be ruled out, a causal relationship cannot be established. Overall, the provision of this guidance and management may be associated with maintaining stable home care.