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May 15 2014
Study Finds Only 3.2% of Hospital Patients Coded with Malnutrition

Although numerous studies find that malnutrition is present in between 33% - 50% hospitalized patients,i,ii,iii recent research published in the Journal of Parenteral and Enteral Nutrition finds only 3.2 percent of all U.S. hospital patients were coded with a diagnosis of malnutrition in 2010.

The study, sponsored by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and involving researchers from a number of academic and non-profit institutions, analyzed 2010 data from the U.S. Department of Health & Human Services sponsored Healthcare Cost and Utilization Project (HCUP). The study utilizes representative data for all U.S. hospitalizations, including up to 25 ICD-9 diagnosis codes for each discharged patient. Using the reported ICD-9 codes to identify how many patients were given a diagnosis of malnutrition, the study reported a much smaller number of malnourished patients than were identified through previous studies using specialized assessment instruments.

Although this study reported a three-fold increase in patients coded with a malnutrition diagnosis since 1993 (when just over 1 percent of patients were diagnosed), the findings represent a call-to-action for policymakers and clinicians to better address standards, diagnostic codes, and best practice protocols for patient malnutrition in the hospital setting. Putting this need into context, a blog post on the Hospital Leader, the official blog of the Society for Hospital Medicine (SHM), estimates one in 30 patients has a documented diagnosis of malnutrition, meaning a 10-fold malnutrition gap exists in U.S. hospitals.

In addition to documenting the scope of the problem, the study identified a number of characteristics associated with patients who receive a diagnosis of malnutrition. The study found these patients are:

  • Significantly older (64.8 years old versus 47.8)
  • Non-Hispanic whites (69.8% versus 65%)
  • Typically men (57.8% versus 53.1%)
  • Fall below the 50th percentile of income (57.9% versus 55%)
  • Stay longer in the hospital (12.6 days versus 4.4 days)
  • Cost more ($26,944 versus $9,485)
  • emergently or urgently (80% versus 60%)
  • Have a discharge of death (5 times more likely)

Read more about the results of this study.

With this new information as the foundation, Karim Godamunne, MD, MBA, SFHM, who authored the blog post on the study’s findings for the Hospital Leader, urged hospitalists to “to remember to use our clinical skills to assess the patient nutritionally, looking for signs of starvation, ongoing chronic and/or acute inflammation.” Specifically, Dr. Godamunne called on hospitalists to document malnutrition as a diagnosis and also take these specific steps to identify and treat malnourished patients quickly:

  1. Take a good history and conduct a thorough physical, and other functional and subjective parameters;
  2. Intervene promptly with the malnourished patient – don’t wait 72 hours to begin treatment; and
  3. Work collaboratively with other members of the health care team (nurses and dietitians) to improve processes, develop systems of care, promote the use of standardized screening tools and utilize educational opportunities to promote nutrition.

Learn more about Dr. Godamunne’s perspective.

1 Coats KG et al. J Am Diet Assoc 1993; 93: 27-33

2 Giner M et al. Nutrition 1996; 12: 23-29.

3Thomas DR et al. Am J Clin Nutr 2002; 75: 308-313.