Abstract

MORAN LOPEZ, Jesús Manuel et al. Efficiency, cost-effectiveness and justification of need for investment in nutrition therapy in a hospital of third level: the role of specialists in endocrinology and nutrition and the coding unit. Nutr. Hosp. [online]. 2015, vol.31, n.4, pp.1868-1873. ISSN 1699-5198.  https://dx.doi.org/10.3305/nh.2015.31.4.8512.

Disease Related Malnutrition (DRM) is highly prevalent in Spanish hospitals. WHO estimates that 20-40% of health-associated expenses are lost due to inefficiency. Demonstration that DRM is a component of inefficiency and hiring a specialist physician for its detection and treatment is cost-effective. Matherial and methods: Comparison between nutritional diagnosis and procedures detected and encoded at discharge using McNemar test. Recoding of 55 discharge reports including nutritional diagnoses and procedures. Determine changes on Case-Mix Index (IC), cost of procedure and cost procedure/GRD index. Comparison using Wilcoxon test. Results: Only 2 of 55 diagnoses of malnutrition were coded in delivery statements (p<0,001). After right codification, IC increased in 42,67 GRD points (p<0,05). Consequently, procedure cost/GRD index was reduced in 976,81€ (p<0,05) Conclusions: DRM is underdiagnosed in our hospital. DRM and nutritional procedures detection by a specialist on endocrinology and nutrition led to a reduction in cost procedure/GRD index of 20% of officially established by the Health System. Loss of 20% of health expenses, estimated in 172690€ was described. Proper codification would have justified 154581€ reimbursement just for nutritional diagnoses and processes. Both expenses were lost due to system's inefficiency. Those amounts are much higher than cost associated of hiring a specialist, so there is no economic reason for denying it.

Keywords : Disease related malnutrition; Cost; Inefficiency; Cost-effectiveness.

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