Reilly J J, Hull S F, Albert N, Waller A, Bringardener S
Presbyterian-University Hospital, Pittsburgh, Pennsylvania.
JPEN J Parenter Enteral Nutr. 1988 Jul-Aug;12(4):371-6. doi: 10.1177/0148607188012004371.
A retrospective review of 771 patients' charts in two acute care hospitals was performed to determine likelihood of malnutrition (LOM) at admission and to assess the effect of LOM on costs and charges. Using accepted criteria, LOM was present in 59 and 48% of medical and surgical patients, respectively. Patients with LOM were 2.6 or 3.4 times as likely to have a predefined minor or major complication, respectively; and 3.8 times as likely to die as patients without LOM (all p less than 0.001). In every diagnosis-related group, the mean length of stay was longer for LOM patients (range 1.1-12.8 excess days). Accountants converted charges to direct variable costs using departmental cost-to-charge ratios. LOM status increased excess costs and charges per patient by $1738 and $3557, respectively (p less than 0.0001). When complications occurred, LOM patients incurred $2996 or $6157 excess costs and charges per patient (p less than 0.01). Serum albumin was the strongest clinical predictor of cost. The hospitals' cost of providing enteral or parenteral nutrition support was $18 or $102 per day, respectively. Too few patients received early nutrition support to assess efficacy. Nonetheless, the costs associated with malnutrition warrant early detection and aggressive treatment.
对两家急症医院771例患者的病历进行回顾性研究，以确定入院时营养不良的可能性（LOM），并评估LOM对成本和费用的影响。根据公认标准，内科和外科患者中分别有59%和48%存在LOM。有LOM的患者发生预先定义的轻度或重度并发症的可能性分别是无LOM患者的2.6倍或3.4倍；死亡可能性是无LOM患者的3.8倍（所有p均小于0.001）。在每个诊断相关组中，LOM患者的平均住院时间更长（额外天数范围为1.1 - 12.8天）。会计人员使用科室成本与收费比率将费用换算为直接可变成本。LOM状态使每位患者的额外成本和费用分别增加了1738美元和3557美元（p小于0.0001）。发生并发症时，LOM患者每位患者的额外成本和费用为2996美元或6157美元（p小于0.01）。血清白蛋白是成本最强的临床预测指标。医院提供肠内或肠外营养支持的成本分别为每天18美元或102美元。接受早期营养支持的患者太少，无法评估疗效。尽管如此，与营养不良相关的成本仍需要早期发现和积极治疗。
