Defining and quantifying preventable and non-preventable hospital-acquired malnutrition-A cohort study

Area of Science:

• Clinical Nutrition
• Health Economics
• Hospital Management

Background:

• Hospital-acquired malnutrition (HAM) is a significant concern impacting patient outcomes and healthcare costs.
• Quantifying HAM and differentiating between preventable and non-preventable cases is crucial for targeted interventions.
• Current government frameworks may not adequately incentivize the reduction of preventable HAM.

Purpose of the Study:

• To define and quantify hospital-acquired malnutrition, distinguishing between preventable and non-preventable cases.
• To identify the primary causes contributing to preventable malnutrition within a hospital setting.
• To assess potential cost savings for a quaternary hospital by implementing a theoretical model focused on penalizing only preventable HAM.

Main Methods:

• A retrospective audit of electronic medical records was performed to identify and re-evaluate cases of HAM.
• Costs associated with HAM were calculated using the Independent Hospital Pricing Authority's (IHPA) principles for hospital-acquired complications.
• A theoretical costing model was developed to compare penalties under the current framework versus a model focusing on preventable HAM.

Main Results:

• Out of 15,419 admissions, 23 cases of HAM were identified over a 3-month period.
• Seventy percent (16 cases) of HAM were classified as preventable, while 9% (2 cases) were non-preventable.
• The current IHPA model estimated total HAM costs at $162,600 over 3 months; a theoretical model focusing on preventable HAM suggested costs of $98,600, yielding savings of $64,000 (40%).

Conclusions:

• The majority of hospital-acquired malnutrition cases possess a preventable component.
• A costing model that penalizes only preventable HAM is proposed to encourage targeted interventions.
• Implementing such a model could lead to significant cost savings for hospitals and improve patient health outcomes by addressing actionable causes of malnutrition.