Original Article
Home Parenteral Nutrition: Survival, Cost, and Quality of Life

https://doi.org/10.1053/j.gastro.2005.09.065Get rights and content

This article summarizes what is known about which factors influence survival of patients on home parenteral nutrition, the costs related to this therapy, and the quality of life for patients living on home parenteral nutrition. The article refers to both North American and European experiences with this complex therapy.

Section snippets

Survival on HPN

A number of factors have been shown to effect survival of patients on HPN.

Cost of HPN

After a number of academic centers reported good rehabilitation of chronic intestinal failure patients on HPN,14, 15, 16, 17, 18, 19, 20, 21, 22 Medicare devised a reimbursement mechanism under the Prosthetic Device Benefit23 and Medicaid and private insurance companies followed suit. Although this was an expensive home technology, providing PN at home, rather than in the hospital, appeared to cut the total management cost by about half.

Until the mid-1980s Medicare was paying for HPN through

Quality of Life on HPN

Quality of life (QOL) assessments need to include emotional, social, occupational, and physical parameters. The most relevant information comes directly from the patient.

Measuring techniques used in HPN patients have involved both QOL assessments made by the patient and rehabilitation assessments made by supervising clinicians. Assessment techniques that directly involve the patient or a close family member (parent) can be divided into 3 types. (1) Instruments that are well-validated for use in

Conclusions and Critical Issues for the Future

Although many factors that influence HPN outcome are relatively immutable, for example, the primary diagnosis, the length and type of remaining bowel, and the patient’s age, other factors can be changed to improve patient outcome, notably patient and family interaction with an effective peer-support and education organization,29 and clinical supervision by an experienced HPN team. These factors are relevant especially to patients expected to survive more than a year on therapy.

Currently HPN and

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    Supported by the National Institutes of Health.

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