Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland; Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
Clin Nutr. 2018 Apr;37(2):681-686. doi: 10.1016/j.clnu.2017.02.012. Epub 2017 Feb 20.
BACKGROUND & AIMS: Undernutrition is associated with increased hospital costs. Whether these increased costs are totally compensated by third payer systems has not been assessed. We aimed to assess the differences between actual and reimbursed hospital costs according to presence/absence of nutritional risk, defined by a Nutritional risk screening-2002 (NRS-2002) score ≥3.
Retrospective study. Administrative data for years 2013 and 2014 of the department of internal medicine of the Lausanne university hospital. The data included total and specific costs (i.e. clinical biology, treatments, pathology). Reimbursed costs were based on the Swiss Diagnosis Related Group (DRG) system.
2200 admissions with NRS-2002 data were included (mean age 76 years, 53.9% women), 1398 (63.6%) of which were considered nutritionally 'at-risk'. After multivariate adjustment, patients nutritionally 'at-risk' had higher costs (multivariate-adjusted difference ± standard error: 34,206 ± 1246 vs. 22,214 ± 1666 CHF, p < 0.001) and higher reimbursements (26,376 ± 1105 vs. 17,783 ± 1477 CHF, p < 0.001). Still, the latter failed to cover the costs, leading to a deficit between costs and reimbursements of 7831 ± 660 CHF in patients 'at-risk' vs. 4431 ± 881 in patients 'not at-risk' (p < 0.003). Being nutritionally 'at-risk' also led to a lower likelihood of complete coverage of costs: multivariate-adjusted odds ratio and 95% confidence interval 0.77 (0.62-0.97). Patients 'at-risk' had lower percentage of total costs in medical interventions, food, imaging and "other", but the absolute differences were less than 2%.
Hospital costs of patients nutritionally 'at-risk' are less well reimbursed than of patients 'not at-risk'. Better reporting of undernutrition in medical records and better reimbursement of undernourished patients is needed.
营养不良与住院费用增加有关。这些增加的费用是否完全由第三方支付系统补偿尚未评估。我们旨在根据营养风险筛查 2002 评分（NRS-2002）≥3 来评估存在/不存在营养风险的情况下，实际与报销的住院费用之间的差异。
回顾性研究。对洛桑大学医院内科 2013 年和 2014 年的行政数据进行分析。数据包括总费用和特定费用（即临床生物学、治疗、病理学）。报销费用基于瑞士诊断相关组（DRG）系统。
共纳入 2200 例有 NRS-2002 数据的患者（平均年龄 76 岁，53.9%为女性），其中 1398 例（63.6%）被认为存在营养风险。多变量调整后，存在营养风险的患者的费用更高（多变量调整差异±标准误差：34206±1246 与 22214±1666 瑞士法郎，p<0.001），报销费用也更高（26376±1105 与 17783±1477 瑞士法郎，p<0.001）。尽管如此，后者仍未能覆盖成本，导致存在营养风险的患者的成本与报销之间存在 7831±660 瑞士法郎的赤字，而不存在营养风险的患者则为 4431±881 瑞士法郎（p<0.003）。存在营养风险还导致成本完全覆盖的可能性降低：多变量调整后的比值比和 95%置信区间为 0.77（0.62-0.97）。存在营养风险的患者的医疗干预、食物、影像和“其他”方面的总费用比例较低，但绝对差异小于 2%。
存在营养风险的患者的住院费用报销不如不存在营养风险的患者好。需要更好地在医疗记录中报告营养不良，并更好地报销营养不良患者的费用。
