Robinson G, Goldstein M, Levine G M
JPEN J Parenter Enteral Nutr. 1987 Jan-Feb;11(1):49-51. doi: 10.1177/014860718701100149.
A prospective audit of 100 admissions to a general medical unit was performed to determine the relationship of the initial nutritional status of the patients to the actual length of stay and hospital charges. These data then were compared with the allowed length of stay and estimated reimbursement under the prospective payment system of diagnosis-related groups (DRGs). Forty-five percent of the malnourished patients were hospitalized longer than that allowed under DRGs, compared to 30% for normal patients and 37% in the borderline group. The average length of stay was 15.6 +/- 2.2 days in the malnourished group compared to approximately 10 days in the other two groups (p less than 0.01). Although the estimated base DRG reimbursement was similar in all three groups ($4352-$5124), the actual hospital charges were significantly greater in the malnourished ($16,691 +/- 4389) and borderline ($14,118 +/- 4962) groups compared to normals ($7692 +/- 687), (p less than 0.01). The DRG system will have an adverse financial impact in the care of malnourished patients. It is suggested that early recognition of malnutrition and aggressive treatment may lead to a decrease in the length of stay and cost deficit incurred by malnourished patients.
对一个普通内科病房的100例入院患者进行了前瞻性审计，以确定患者的初始营养状况与实际住院时间和医院费用之间的关系。然后将这些数据与根据诊断相关分组（DRG）前瞻性支付系统允许的住院时间和估计报销费用进行比较。45%的营养不良患者住院时间超过DRG允许的时间，正常患者为30%，边缘组为37%。营养不良组的平均住院时间为15.6±2.2天，而其他两组约为10天（p<0.01）。尽管三组的估计基础DRG报销费用相似（4352美元至5124美元），但营养不良组（16691±4389美元）和边缘组（14118±4962美元）的实际医院费用明显高于正常组（7692±687美元），（p<0.01）。DRG系统将对营养不良患者的护理产生不利的财务影响。建议早期识别营养不良并积极治疗可能会缩短营养不良患者的住院时间并减少费用赤字。
