Ajay Bhasin MD, Lynn Huang MS, Meng-Shoiu Shieh PhD, Penelope Pekow PhD, Peter K. Lindenauer MD, MS, Tara Lagu MD, MPH
{"title":"2016-2019 年美国住院成人营养不良情况。","authors":"Ajay Bhasin MD, Lynn Huang MS, Meng-Shoiu Shieh PhD, Penelope Pekow PhD, Peter K. Lindenauer MD, MS, Tara Lagu MD, MPH","doi":"10.1002/jhm.13456","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Malnutrition in hospitalized patients is associated increased length of stay, cost, readmission, and death. No recent studies have examined trends in prevalence or outcomes of hospitalized patients with a diagnosis of malnutrition.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To study the prevalence of malnutrition diagnostic codes and associated hospital outcomes in the United States between 2016 and 2019.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We conducted a retrospective trends study to identify use of malnutrition codes in hospitalizations in the National Inpatient Sample between 2016 and 2019. We used direct standardization by logistic regression to adjust outcomes of percutaneous gastrostomy tube placement, mechanical ventilation, and death for age, Gagne comorbidity score, and sex. We then used linear regression to test for trends over time by malnutrition type.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Across all hospitalizations, codes for diagnoses of nonsevere malnutrition and severe malnutrition were present in 3.7% and 4.1% of hospitalizations, respectively. Codes for any malnutrition increased over time, from 6.6% in 2016 to 8.6% in 2018 (<i>p</i> = .03). Codes for severe malnutrition increased from 3.3% to 4.7% (<i>p</i> = .01). Among hospitalizations with coded severe malnutrition diagnoses, there was a statistically significant decrease in adjusted rate of death over time (−0.54% per year, <i>p</i> = .03) which was not seen in hospitalizations without coded malnutrition diagnoses.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Use of malnutrition diagnosis codes increased significantly from 2016 to 2019. During this time, mortality among hospitalizations with a diagnosis code for severe malnutrition decreased. Though the increased prevalence of malnutrition codes may represent a change in the clinical characteristics of hospitalized patients, the decline in mortality suggests some of the increase may be due to lower threshold for coding and assignment of the diagnosis to less ill patients.</p>\n </section>\n </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 12","pages":"1113-1121"},"PeriodicalIF":2.4000,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhm.13456","citationCount":"0","resultStr":"{\"title\":\"Malnutrition in hospitalized adults in the United States, 2016–2019\",\"authors\":\"Ajay Bhasin MD, Lynn Huang MS, Meng-Shoiu Shieh PhD, Penelope Pekow PhD, Peter K. Lindenauer MD, MS, Tara Lagu MD, MPH\",\"doi\":\"10.1002/jhm.13456\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Malnutrition in hospitalized patients is associated increased length of stay, cost, readmission, and death. No recent studies have examined trends in prevalence or outcomes of hospitalized patients with a diagnosis of malnutrition.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>To study the prevalence of malnutrition diagnostic codes and associated hospital outcomes in the United States between 2016 and 2019.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We conducted a retrospective trends study to identify use of malnutrition codes in hospitalizations in the National Inpatient Sample between 2016 and 2019. We used direct standardization by logistic regression to adjust outcomes of percutaneous gastrostomy tube placement, mechanical ventilation, and death for age, Gagne comorbidity score, and sex. We then used linear regression to test for trends over time by malnutrition type.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Across all hospitalizations, codes for diagnoses of nonsevere malnutrition and severe malnutrition were present in 3.7% and 4.1% of hospitalizations, respectively. Codes for any malnutrition increased over time, from 6.6% in 2016 to 8.6% in 2018 (<i>p</i> = .03). Codes for severe malnutrition increased from 3.3% to 4.7% (<i>p</i> = .01). Among hospitalizations with coded severe malnutrition diagnoses, there was a statistically significant decrease in adjusted rate of death over time (−0.54% per year, <i>p</i> = .03) which was not seen in hospitalizations without coded malnutrition diagnoses.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Use of malnutrition diagnosis codes increased significantly from 2016 to 2019. During this time, mortality among hospitalizations with a diagnosis code for severe malnutrition decreased. 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Malnutrition in hospitalized adults in the United States, 2016–2019
Background
Malnutrition in hospitalized patients is associated increased length of stay, cost, readmission, and death. No recent studies have examined trends in prevalence or outcomes of hospitalized patients with a diagnosis of malnutrition.
Objectives
To study the prevalence of malnutrition diagnostic codes and associated hospital outcomes in the United States between 2016 and 2019.
Methods
We conducted a retrospective trends study to identify use of malnutrition codes in hospitalizations in the National Inpatient Sample between 2016 and 2019. We used direct standardization by logistic regression to adjust outcomes of percutaneous gastrostomy tube placement, mechanical ventilation, and death for age, Gagne comorbidity score, and sex. We then used linear regression to test for trends over time by malnutrition type.
Results
Across all hospitalizations, codes for diagnoses of nonsevere malnutrition and severe malnutrition were present in 3.7% and 4.1% of hospitalizations, respectively. Codes for any malnutrition increased over time, from 6.6% in 2016 to 8.6% in 2018 (p = .03). Codes for severe malnutrition increased from 3.3% to 4.7% (p = .01). Among hospitalizations with coded severe malnutrition diagnoses, there was a statistically significant decrease in adjusted rate of death over time (−0.54% per year, p = .03) which was not seen in hospitalizations without coded malnutrition diagnoses.
Conclusions
Use of malnutrition diagnosis codes increased significantly from 2016 to 2019. During this time, mortality among hospitalizations with a diagnosis code for severe malnutrition decreased. Though the increased prevalence of malnutrition codes may represent a change in the clinical characteristics of hospitalized patients, the decline in mortality suggests some of the increase may be due to lower threshold for coding and assignment of the diagnosis to less ill patients.
期刊介绍:
JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children.
Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.