Stollhof Laura E, Braun Jessica M, Ihle Christoph, Schreiner Anna J, Kufeldt Johannes, Adolph Michael, Wintermeyer Elke, Stöckle Ulrich, Nüssler Andreas
Department of Traumatology, BG Unfallklinik Tübingen, Siegfried Weller Institute for Trauma Research, Eberhard Karls Universität Tübingen.
EXCLI J. 2019 Jun 12;18:370-381. doi: 10.17179/excli2019-1256. eCollection 2019.
It has been internationally recognized that malnutrition is an independent risk factor for patients' clinical outcome. A new mandatory fixed price payment system based on diagnosis-related groups (G-DRG) went into effect in 2004. The aim of our study was to demonstrate the importance of carefully coding the secondary diagnosis of "malnutrition" in the G-DRG system and to highlight how the economic relevance of malnutrition in the G-DRG system has changed from 2014 to 2016. 1372 inpatients at the Berufsgenossenschaftliche Unfallklinik (Trauma Center) in Tübingen were screened for the risk of malnutrition using Nutritional Risk Screening (NRS-2002). Patient data were compared with the NRS values collected during the study and a case simulation was carried out separately for each year. We used the codes E44.0 for NRS = 3 and E43.0 for NRS > 3. The ICD codes were entered as an additional secondary diagnosis in the internal hospital accounting system DIACOS to determine possible changes in the effective weight. In 2014 the highest additional revenue by far was calculated by coding malnutrition. For the 638 patients enrolled in the study in 2014, we were able to calculate an average additional revenue per patient coded with malnourishment of €107. In 2016, we were unable to calculate any additional revenue for the 149 patients enrolled. Although it is well known that malnutrition is an independent risk factor for poor patient outcomes, nationwide screening for a risk of malnutrition when patients are admitted to a hospital is still not required. For this reason, malnutrition in German hospitals continues to be insufficiently documented Due to the continuous downgrading of diagnosis-related severity (CCL) of malnutrition in the G-DRG system in trauma surgery patients, it is no longer possible to refinance the costs incurred by malnourished patients through the conscientious coding of malnutrition. We assume that the indirect positive effects of nutritional interventions will have to be taken into account more in the costing calculations and possibly lead to indirect cost compensation.
国际上已公认营养不良是影响患者临床结局的独立风险因素。一种基于诊断相关分组（G-DRG）的新的强制性固定价格支付系统于2004年生效。我们研究的目的是证明在G-DRG系统中仔细编码“营养不良”二级诊断的重要性，并强调2014年至2016年期间营养不良在G-DRG系统中的经济相关性如何变化。对图宾根职业事故诊所（创伤中心）的1372名住院患者使用营养风险筛查（NRS-2002）进行营养不良风险筛查。将患者数据与研究期间收集的NRS值进行比较，并每年分别进行病例模拟。对于NRS = 3，我们使用代码E44.0；对于NRS> 3，使用代码E43.0。将ICD代码作为附加二级诊断输入医院内部计费系统DIACOS，以确定有效权重的可能变化。2014年，通过对营养不良进行编码计算出的额外收入迄今为止最高。对于2014年纳入研究的638名患者，我们能够计算出每名编码为营养不良的患者平均额外收入为107欧元。2016年，我们无法为纳入的149名患者计算任何额外收入。尽管众所周知营养不良是患者预后不良的独立风险因素，但全国范围内仍未要求在患者入院时对营养不良风险进行筛查。因此，德国医院中营养不良的记录仍然不足。由于创伤外科患者的G-DRG系统中营养不良的诊断相关严重程度（CCL）不断降低，因此不再可能通过对营养不良进行认真编码来为营养不良患者产生的费用提供再融资。我们假设在成本计算中必须更多地考虑营养干预的间接积极影响，并可能导致间接成本补偿。
