Management of Undernutrition on Discharge From Hospital by Dieticians and Physical Activity Teachers at Home

Assessment of patient compliance with the innovative program will be based on their participation in the various consultations under the protocol (medical, dietary, physical rehabilitation), as well as in their adapted physical activity program. The clinical research associate in charge of the study will collect these data from the data transmitted by the professionals in charge of the patient's follow-up (physician, dietician, EAPA), as well as from the follow-up booklet completed by the patient.

Adherence will be measured by analyzing deviations from consultations and APA sessions scheduled as part of the protocol, by category:

• Medical: 2 scheduled consultations (attending general practitioner + hospital physician)
• Dietetics: 3 consultations planned
• Adapted physical activity: number of sessions varies according to the program defined by the EAPA

Grip strength will be assessed using the handgrip, enabling muscle strength to be measured in kg. The grip strength test will be performed according to the Southampton protocol.

Chair-lifting speed is assessed by the 5 chair-lifts test. This is a benchmark test for assessing muscle strength.

Walking speed is assessed by the 4-meter walking test (4MWT). Walking speed over 4 meters is assessed to the nearest 0.01 second using a stopwatch. The test will be carried out twice in succession, and the fastest walking speed, expressed in m/s, will be used.

Weight will be measured in kilograms. Weight measurements at D0 and M3 will be taken on the same model of scale. As weight measurement at M1 is carried out at the attending physician's, the scale used will be different from that used for the other two measurement points.

The status of "undernourished" / "not undernourished" will be determined on the basis of the definition given in the latest HAS recommendations (Diagnosis of undernutrition in children and adults - November 2019 and Diagnosis of undernutrition in people aged 70 and over - November 2021).

The results of these biological parameters prescribed as standard for monitoring undernutrition will be recorded during the three medical visits, if values are available. The unit of measurement for these blood parameters will be the mmol/L.

The results of these biological parameters prescribed as standard for monitoring undernutrition will be recorded during the three medical visits, if values are available. The unit of measurement for these blood parameters will be the UI/L.

The results of these biological parameters prescribed as standard for monitoring undernutrition will be recorded during the three medical visits, if values are available. The unit of measurement for these blood parameters will be the g/L.

Patients' quality of life will be assessed using the EQ-5D-5L questionnaire at three medical visits. The EQ-5D-5L questionnaire consists of a descriptive section and a visual analog scale. The descriptive part comprises five dimensions: mobility, personal care, usual activities, pain/discomfort and anxiety/depression. Each dimension is rated by the patient according to 5 degrees: no problems, mild problems, moderate problems, severe problems and extreme problems. The visual scale is a vertical analog scale, with the ends labelled "the best health you can imagine" (score : 100) and "the worst health you can imagine" (score : 0). The difference in score between the baseline and the two follow-up visits will be measured.

The number of re-hospitalized and deceased patients will be collected by the CRA from the patient's medical file and after discussion with the healthcare professionals in charge of the patient's follow-up.

It will be assessed using a 5-point satisfaction scale, from very dissatisfied to very satisfied.

The use of dietary consultations, out-of-protocol physical rehabilitation sessions and complementary general medical consultations will be recorded by the CRA using a follow-up booklet completed by the patient.

The satisfaction of each professional involved (doctor, dietician, EAPA) in this protocol for the early management of undernutrition will be assessed using a 5-point satisfaction scale, from very dissatisfied to very satisfied.

A cost-utility analysis will be carried out from both a societal and a health insurance perspective, in order to measure the relevance of the allocative efficiency of expenditure at M3. Utility will be calculated in relation to quality of life as measured by the EQ-5D-5L. Costs will be calculated on the basis of the following data:

• For direct medical and non-medical costs: cost of medical treatment, cost of consultations, cost of complementary biological and radiological examinations, cost of medical transport and out-of-pocket expenses for patients;
• For indirect costs: daily benefits related to work stoppage;
• For intangible costs: psychological consequences of illness.