By Staci Hemesath, Board Certified Specialist in Renal Nutrition, Registered Dietitian
Based on new research published in the Journal of Parenteral and Enteral Nutrition (Corkins, et al., 2014), there is an alarming number of undiagnosed malnourished patients in U.S. hospitals. Findings from the 2010 Healthcare Cost and Utilization Project revealed that only 3.2% of hospitalized patients were correctly coded as malnourished.
The Malnutrition Gap
But how many patients arrive at the hospital malnourished? Between 33%-54%, depending on the study. This means roughly 1/3 to 1/2 of hospitalized patients are not being properly coded as malnourished! Plus, among patients that are not malnourished upon admission, approximately one third may become malnourished while in the hospital.
If left untreated, two thirds of these malnourished patients will suffer a greater decline in nutritional status during their hospital stay. This translates to a significant number of patients leaving the hospital in a nutritionally compromised state.
As an outpatient dialysis dietitian, I have witnessed the post-discharge downward spiral of many of my patients. It’s concerning that they go to the hospital to “get better,” but often leave in a weak, malnourished state. And in many cases, they either:
1) Get readmitted after suffering a fall at home or being diagnosed with an infection or
2) Get admitted to a nursing home with a further decline in functional status
It is sad to see and makes me ponder what can be done to improve this reality.
This “malnutrition gap” reveals a tremendous opportunity to optimize quality of patient care, improve clinical outcomes, and reduce cost. My example above highlights a few of the common adverse outcomes of malnutrition, but there are many others.
Prompt Diagnosis is Critical – New ICD-10 Codes May Help
Identifying and treating malnutrition early on is a critical step in addressing hospital malnutrition.
- New ICD-10 Codes: A promising step in the right direction is the mandatory implementation of ICD-10 codes, effective October 1, 2015. The new codes require users to more specifically define each health condition. In doing so, nutrition-related issues are more likely to be identified and institutions can be reimbursed appropriately. Successful implementation of this process can result in significant gains in hospital revenue.
Nutrition Care Model: The Alliance to Advance Patient Nutrition, an interdisciplinary collaboration of the Academy of Nutrition & Dietetics and other industry leaders, has developed a nutrition care model (Tappenden, et al., 2013) with six principles designed to improve hospital nutrition practices. One of the key principles, which is often overlooked, is the inclusion of nutrition in the discharge planning process. Ensuring that nutrition is part of the transition to home is crucial in preventing hospital readmissions.
Patients and caregivers must be given detailed instructions for nutrition care at home, and nutrition should be an essential component of follow-up appointments. Also, dietitians should be involved in the care transitions process so that appropriate interventions can be implemented, recommended, and monitored.
Dr. Sam Beattie’s discussion of nutrition reconciliation sums up this process well.
The new ICD-10 Codes and the Alliance nutrition care model are some great tools to help combat malnutrition and improve outcomes. What other tools or resources do you know of that could help?