Fernandes Ana Campos, Pessoa Ana, Vigário Maria Antónia, Jager-Wittenaar Harriët, Pinho João
Instituto de Saúde Pública da Universidade do Porto, Univeridade do Porto, Portugal.
Internal Medicine, Centro Hospitalar Médio Ave, Vila Nova de Famalicão, Portugal.
Nutrition. 2020 Jun;74:110750. doi: 10.1016/j.nut.2020.110750. Epub 2020 Jan 25.
The aim of this study was to determine how diagnosing and coding of malnutrition in an internal medicine ward setting influences potential hospital reimbursement.
Patients admitted to the internal medicine ward of Centro Hospitalar do Médio Ave between April 24 and May 22, 2018 were screened by Nutritional Risk Screening 2002, and patients classified as at "risk for malnutrition" were assessed by the Patient-Generated Subjective Global Assessment (PG-SGA). For each patient, medical coders simulated coding, taking into account the malnutrition diagnosis by PG-SGA, and compared it with the real coding as retrieved from the medical records. For the coding, the Diagnosis-Related Group and Severity of Illness were determined, allowing the calculation of hospitalization cost (HC) according to Portuguese Ministerial Directive number 207/2017. The increase of HC in this subsample was extrapolated to the number of patients admitted during 2018, to obtain the estimated unreported annual HC.
Of the 71% (92/129) participants having malnutrition risk according to Nutritional Risk Screening 2002, 86% were malnourished. Including malnutrition diagnosis in the coding of malnourished patients increased the level of Severity of Illness in 39% of cases and increased HC for this subsample, resulting in €52 000. Extrapolating for the annual HC, total HC reached €1.3 million.
Identifying malnourished patients and including this highly prevalent diagnosis in medical records allows malnutrition coding and consequent increase of HC. This can improve the potential hospital reimbursement, which could contribute to the quality of patient care and economic sustainability of hospitals.
本研究旨在确定内科病房环境中营养不良的诊断和编码如何影响潜在的医院报销。
对2018年4月24日至5月22日入住米迪奥阿韦中央医院内科病房的患者进行2002年营养风险筛查，对被归类为“营养不良风险”的患者采用患者主观全面评定法（PG-SGA）进行评估。对于每位患者，医学编码员在考虑PG-SGA对营养不良的诊断的情况下模拟编码，并将其与从病历中检索到的实际编码进行比较。对于编码，确定诊断相关组和疾病严重程度，从而根据葡萄牙第207/2017号部长指令计算住院费用（HC）。将该子样本中HC的增加量外推至2018年期间入院的患者数量，以获得估计的年度未报告HC。
根据2002年营养风险筛查，71%（92/129）的参与者存在营养不良风险，其中86%为营养不良。在营养不良患者的编码中纳入营养不良诊断，在39%的病例中提高了疾病严重程度水平，并增加了该子样本的HC，达到52000欧元。将年度HC外推，总HC达到130万欧元。
识别营养不良患者并将这一高度普遍的诊断纳入病历可实现营养不良编码并相应增加HC。这可以提高潜在的医院报销水平，有助于提高患者护理质量和医院的经济可持续性。
