Comparison of diagnosis-related group based reimbursement and case-mix index within hospitalized patients before and after modified malnutrition diagnosis.

IF 1.3 4区 医学 Q4 NUTRITION & DIETETICS
Xiangrui Li, Lihua Yuan, Bo Gao, Wenqing Chen, Shu'an Wang, Ying Xie, Xiaoqi Zhang, Xiaotian Chen
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Abstract

Background and objectives: Lack of professional and accurate diagnosis of malnutrition led to a reduction in Diagnosis Related Group (DRG) payment and a decrease in Case-Mix Index (CMI). The aim of this study was to explore the effects of adding a proper nutritional diagnosis and modifying complication groups on DRG payment and CMI.

Methods and study design: Retrospective analysis was performed on patients ad-mitted to the hospital from January to June 2022 who had received a nutritional assessment. Patients were diagnosed as well-nourished, mild malnutrition, moderate malnutrition or severe malnutrition according to patient-generated subjective global assessment (PG-SGA) scores within 24 hours of admission. CMI and DRG hospital internal control standards were recalculated and compared with the original values.

Results: A total of 254 patients were enrolled, including 40 patients with mild malnutrition, 74 patients with moderate malnutrition and 122 patients with severe malnutrition. Of all subjects, 111 changed complication groups. The median of the DRG hospital internal control standard (12006.09 vs. 13797.19, p=0.01) and the median of CMI (0.91 vs. 1.04, p=0.026) were significantly higher than those before the diagnostic change. In patients with inflammatory bowel disease (IBD), the CMI value, hospital control standard of DRG, and the classification of DRG were significantly different from those before diagnosis revision (p<0.001).

Conclusions: Fully identification and correct coding of malnutrition cases are conducive for hospitals to receive appropriate DRG compensation, and further contribute to the improvement of medical quality and the economic sustain-ability of hospitals.

改良营养不良诊断前后住院患者中基于诊断相关群体的报销和病例组合指数的比较。
背景和目的:缺乏营养不良的专业和准确诊断导致诊断相关组(DRG)付款减少和病例组合指数(CMI)下降。本研究的目的是探讨增加适当的营养诊断和修改并发症组对DRG付款和CMI的影响。方法和研究设计:对2022年1月至6月入院接受营养评估的患者进行回顾性分析。根据患者在入院后24小时内的主观总体评估(PG-SGA)评分,患者被诊断为营养良好、轻度营养不良、中度营养不良或严重营养不良。对CMI和DRG医院内部控制标准进行了重新计算,并与原始值进行了比较。结果:共有254名患者入选,其中轻度营养不良患者40名,中度营养不良患者74名,重度营养不良患者122名。在所有受试者中,111个改变了并发症组。DRG医院内部控制标准的中位数(12006.09 vs.13797.19,p=0.01)和CMI的中位数(0.91 vs.1.04,p=0.026)显著高于诊断变化前。在炎症性肠病(IBD)患者中,结论:营养不良病例的充分识别和正确编码有利于医院获得适当的DRG补偿,有助于提高医疗质量和医院的经济维持能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.50
自引率
7.70%
发文量
58
审稿时长
6-12 weeks
期刊介绍: The aims of the Asia Pacific Journal of Clinical Nutrition (APJCN) are to publish high quality clinical nutrition relevant research findings which can build the capacity of clinical nutritionists in the region and enhance the practice of human nutrition and related disciplines for health promotion and disease prevention. APJCN will publish original research reports, reviews, short communications and case reports. News, book reviews and other items will also be included. The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer-reviewed by at least two anonymous reviewers and the Editor. The Editorial Board reserves the right to refuse any material for publication and advises that authors should retain copies of submitted manuscripts and correspondence as material cannot be returned. Final acceptance or rejection rests with the Editorial Board
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