A Questionnaire Study on the Cost and Challenges of Texture-Modified Diets

Abstract

　Objective: Texture-modified diets (TMDs) must comply with standardized texture classifications and ensure adequate nutrient content. However, the current practices and challenges in preparing TMDs in hospitals remain unclear. This study was conducted to investigate these issues.

　Methods: From April to June 2023, a web-based survey was sent to nutrition management departments across Japan. One representative from each consenting hospital responded. Responses were simply tallied, and outliers were excluded; the survey system was constructed, implemented, and tabulated by an independent third party, complying with the Personal Information Protection Act.

　Results: Responses were received from 905 hospitals (response rate 16.8%). TMDs were provided in 857 hospitals. Among these, 229/827 hospitals reported challenges in preparing TMDs, citing ‘cooks’skills’, ‘understanding of TMDs’, and ‘increased cooking time’ as main barriers. As a cooking indicator, 762/857 hospitals used the Japanese Dysphagia Diet of 2013 or 2021 by The Japanese Society of Dysphagia Rehabilitation (JDD Classification). Quality control for TMDs was predominantly ‘visual inspection before serving’ (707/857 hospitals). The median cost per meal was ¥764 for regular meals (inter-quartile range (IQR) 650–873) and ¥840 for TMDs (IQR: 700–1,000). Hospitals utilizing commercial products for TMDs numbered 599/857, with the primary reasons being ‘reduction in cooking time’ (502/599 hospitals), ‘consistent physical properties’ (433/857 hospitals), and ‘reduction in staffing costs’ (298/599 hospitals). The median nutritional value for TMDs ranged from 600–1,400 kcal and 20–60 g of protein per day, particularly low in code 1. The most common method to supplement insufficient nutrients was the use of oral nutritional supplements (672/741 hospitals). Test foods for videofluoroscopic swallowing study were provided by 456/857 hospitals, with costs often covered by the nutrition management department (311/456 hospitals).

　Conclusion: The results of this survey suggest that providing safe and nutritionally valuable meals requires enhanced knowledge and cooking skills for dysphagia diets, standardization of quality control methods, and appropriate reflection in medical fees.