Malnutrition in Hospitals: It Was, Is Now, and Must Not Remain a Problem!
Malnutrition in Hospitals: It Was, Is Now, and Must Not Remain a Problem!
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DOI：
10.12659/msm.894238
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发表时间：
2015-10-02
期刊：
影响因子：
--
通讯作者：
Zopf Y
中科院分区：
文献类型：
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作者：
Konturek PC;Herrmann HJ;Schink K;Neurath MF;Zopf Y
营养不良是住院患者中一个认识不足的问题。尽管进行了系统的筛查，但在过去的几十年里，医院营养不良的患病率并没有下降。本研究的目的是评估营养不良的患病率，并确定住院患者明确的每日卡路里摄入量，以确定住院期间发生营养不良的危险因素，以及根据德国DRG系统对经济补偿的影响。815例住院患者纳入本研究。营养不良的检测是基于营养风险筛查（NRS）和主观全面评估（SGA）评分。一名经过培训的研究者记录了每名患者的每日卡路里和液体摄入量。此外，还对临床参数和经济补偿进行了评价。营养不良的发生率根据SGA为53.6%，根据NRS为44.6%。住院期间，患者平均接受759.9±546.8 kcal/天。患有肝脏和胃肠道疾病以及抑郁症或痴呆症的患者营养不良的患病率增加。最重要的营养不良的危险因素是卧床休息和不动（OR=5.88，95%CI 2.25-15.4）。在84.5%的患者记录中，营养不良没有正确编码，导致DRG系统的经济损失增加（94.908欧元）。住院病人得不到充分的营养治疗，住院期间营养不良的风险增加。对营养不良患者进行早期筛查不仅可以改善营养治疗的管理，而且在适当编码的情况下，还可以根据DRG系统改善财务报销。
Malnutrition is an under-recognized problem in hospitalized patients. Despite systematic screening, the prevalence of malnutrition in the hospital did not decrease in the last few decades. The aim of our study was to evaluate the prevalence of malnutrition and to determine the explicit daily calorie intake of hospitalized patients, to identify the risk factors of developing malnutrition during hospitalization and the effect on the financial reimbursement according to the German DRG-system. 815 hospitalized patients were included in this study. The detection of malnutrition was based on the nutritional-risk-screening (NRS) and subjective-global-assessment (SGA) scores. A trained investigator recorded the daily calorie and fluid intake of each patient. Furthermore, clinical parameters, and the financial reimbursement were evaluated. The prevalence of malnutrition was 53.6% according to the SGA and 44.6% according the NRS. During hospitalization, patients received on average 759.9±546.8 kcal/day. The prevalence of malnutrition was increased in patients with hepatic and gastrointestinal disease and with depression or dementia. The most important risk factors for malnutrition were bed rest and immobility (OR=5.88, 95% CI 2.25–15.4). In 84.5% of patient records, malnutrition was not correctly coded, leading to increased financial losses according to the DRG-system (94.908 Euros). Hospitalized patients suffer from inadequate nutritional therapy and the risk for developing malnutrition rises during the hospital stay. The early screening of patients for malnutrition would not only improve management of nutritional therapy but also, with adequate coding, improve financial reimbursement according to the DRG-system.