Raja R, Lim A V, Lim Y P, Lim G, Chan S P, Vu C K F
Department of Nutrition and Dietetics, Tan Tock Seng Hospital, Singapore.
Intern Med J. 2004 Apr;34(4):176-81. doi: 10.1111/j.1444-0903.2004.00518.x.
Several studies have cited the incidence of malnutrition in hospitals, which is correlated to negative clinical outcomes, to be up to 60%. Data in Singapore, however, are scarce. Its impact on casemix funding is not known.
The aims of the present study were to determine the prevalence of malnutrition, the predisposing risk factors and the impact of documentation and coding of malnutrition on casemix funding in a local population in Singapore.
Patients admitted to selected wards over a 1-month period were screened for malnutrition. Those at risk were further assessed using subjective global assessment. Logistic regression was used to ascertain the impact of identified factors on malnutrition. Financial impact analysis of coding of malnutrition as a comorbidity was carried out and tested with Wilcoxon signed rank tests.
Six hundred and fifty-eight patients were eligible for screening. The overall prevalence of malnutrition in the selected wards was 14.7% (95% confidence interval (CI): 12.0-17.4%). Old age, the occurrence of cancer and the admitting unit were statistically significant in explaining the occurrence of malnutrition. Coding of malnutrition was found to significantly increase the complexity of 24 of 105 episodes (22.9%) of patient care as measured by expected cost weights (P < 0.001) and expected lengths of stay (P < 0.001). As a result, the expected financing for these 24 patients increased by 59.7%.
Malnutrition is prevalent in hospitalised medical and surgical patients. Certain clinical factors should heighten awareness and prompt detection for malnutrition. Coding for malnutrition impacts favourably on casemix funding for a subset of malnourished patients.
多项研究表明，医院中营养不良的发生率高达60%，且与不良临床结局相关。然而，新加坡的数据却很匮乏。其对病例组合资金的影响尚不清楚。
本研究旨在确定新加坡当地人群中营养不良的患病率、易感风险因素以及营养不良的记录和编码对病例组合资金的影响。
对选定病房在1个月内收治的患者进行营养不良筛查。对有风险的患者进一步采用主观全面评定法进行评估。采用逻辑回归确定已识别因素对营养不良的影响。对将营养不良作为一种合并症进行编码的财务影响进行分析，并采用Wilcoxon符号秩检验进行检验。
658例患者符合筛查条件。选定病房中营养不良的总体患病率为14.7%（95%置信区间（CI）：12.0 - 17.4%）。年龄、癌症的发生情况及收治科室在解释营养不良的发生方面具有统计学意义。通过预期成本权重（P < 0.001）和预期住院时间（P < 0.001）衡量，发现营养不良编码显著增加了105例患者护理中的24例（22.9%）的复杂性。结果，这24例患者的预期资金增加了59.7%。
营养不良在住院的内科和外科患者中普遍存在。某些临床因素应提高对营养不良的认识并促使其得到及时检测。对营养不良进行编码对一部分营养不良患者的病例组合资金有积极影响。
