Current nutrition practices and additional reimbursement of intensive care units in Japan: A cross‐sectional survey study
BACKGROUND: A unique reimbursement for early nutrition intervention was introduced in Japan to promote guideline-adherent nutrition practices in intensive care units. However, the current status of nutrition therapy implementation across Japanese intensive care units remains unclear. METHODS: This cross-sectional survey study investigated intensive care units nationwide, led by the Japanese Society of Intensive Care Medicine. Facility characteristics, nutrition management structure, nutrition practices (nutritional assessment, nutrition planning, therapy implementation, and monitoring), and dietitian involvement were assessed. We examined relationships between reimbursement claim status and nutrition practices. RESULTS: Among 337 intensive care units, most performed nutritional assessment using at least one standardized tool and planned nutrition targeting 25-30 kcal/kg/day for energy and 1.0-1.2 g/kg/day for protein. Enteral nutrition-related practices were widely implemented. Of these, 255 intensive care units (75.7%) claimed the reimbursement; incentivized units more frequently implemented written enteral nutrition protocols, dietitian-conducted nutritional assessments, dietitian-led enteral nutrition design, and enteral nutrition initiation within 48 h. However, Global Leadership Initiative on Malnutrition assessment, indirect calorimetry, written protocols for parenteral nutrition/diarrhea/constipation, dietitian-led parenteral nutrition design, and post-intensive care unit nutritional follow-up remained limited even in incentivized units. CONCLUSION: In Japan, reimbursement incentives were positively associated with higher implementation of nutritional assessment, enteral nutrition-related practices, and dietitian involvement. To further advance specialized nutritional care, simultaneous system development may be warranted.
Authors
- Yoshiyuki Shimizu (ORCID: https://orcid.org/0000-0003-4378-4899)
- Yudai Takatani (ORCID: https://orcid.org/0009-0001-6110-890X)
- Ryo Yamamoto (ORCID: https://orcid.org/0000-0001-8772-9600)
- Rie Tsutsumi (ORCID: https://orcid.org/0000-0001-6362-5823)
- Akira Ouchi (ORCID: https://orcid.org/0000-0003-4740-0098)
- Taku Oshima (ORCID: https://orcid.org/0000-0002-3868-8272)
- Norihiko Tsuboi (ORCID: https://orcid.org/0000-0002-7444-8137)
- Natsuhiro Yamamoto (ORCID: https://orcid.org/0000-0002-6144-0144)
- Junji Hatakeyama (ORCID: https://orcid.org/0000-0003-2290-6965)
- Naoki Higashibeppu (ORCID: https://orcid.org/0000-0003-3262-9850)
- Muneyuki Takeuchi (ORCID: https://orcid.org/0000-0001-9117-3596)
- Nobuto Nakanishi
- Hiroo Izumino
- Joji Kotani (ORCID: https://orcid.org/0000-0003-0808-095X)
- Ayumu Nozaki
- Kensuke Nakamura (ORCID: https://orcid.org/0000-0001-8481-0294)
- Hiroomi Tatsumi (ORCID: https://orcid.org/0000-0002-9688-6154)
- Minoru Yoshida (ORCID: https://orcid.org/0000-0003-0556-9469)
- Isao Miyajima (ORCID: https://orcid.org/0009-0009-3625-6706)
- Tomoka Miyagi (ORCID: https://orcid.org/0009-0008-6945-4939)
- Naoki Kanda
- Fumiaki Ishikawa
- Noriko Tanaka
- Yuya Kokubo
Institutions
- Sapporo Medical University (JP)
- Jichi Medical University (JP)
- Keio University (JP)
- Kyoto Medical Center (JP)
- Ibaraki Christian University (JP)
- Osaka Women's and Children's Hospital (JP)
- Yokohama City University Hospital (JP)
- Chikamori Hospital (JP)
- Japanese Red Cross Medical Center (JP)
- Keio University Hospital (JP)
- National Cerebral and Cardiovascular Center (JP)
- Kanagawa Children's Medical Center (JP)
- Hiroshima University Hospital (JP)
- National Center For Child Health and Development (JP)
- National Hospital Organization (JP)
- Kyoto Katsura Hospital (JP)
- Kyoto University Hospital (JP)
- Jichi Medical University Hospital (JP)
- Nagasaki University Hospital (JP)
- Hitachi (Japan) (JP)
- Kobe University (JP)
- Yokohama City University (JP)
- Osaka University of Pharmaceutical Sciences (JP)
Publication Details
- Journal
- Journal of Parenteral and Enteral Nutrition
- Published
- 2026-10-26
- DOI
- https://doi.org/10.1002/jpen.70161
- Primary Topic
- Clinical Nutrition and Gastroenterology
- Type
- article
- Field-Weighted Citation Impact
- 0.00