Related Experiment Videos
Financial implications of malnutrition
L H Bernstein1, T A Shaw-Stiffel, M Schorow
1Department of Pathology, Bridgeport Hospital, Connecticut.
Insights
Protein-energy malnutrition (PEM) affects 30-50% of hospitalized patients, increasing costs and mortality. Early nutrition support is crucial for managing this condition and its complications.
Area of Science:
- Clinical Nutrition
- Hospital Medicine
- Health Economics
Background:
- Protein-energy malnutrition (PEM) affects 30-50% of hospitalized patients, independent of other conditions.
- PEM results from inadequate nutrient intake, leading to weight loss, functional decline, and impaired immunity.
- It exacerbates existing chronic conditions and increases vulnerability to acute metabolic stress.
Purpose of the Study:
- To analyze the financial implications of malnutrition and nutritional therapy in hospitalized patients.
- To present a model for evaluating the economic impact of PEM and its management.
- To highlight the cost-effectiveness of early nutrition support versus treating complications.
Main Methods:
- Review of existing literature on PEM prevalence, consequences, and costs.
- Analysis of financial data related to hospital length of stay (LOS), complications, and nutrition interventions.
- Development of a financial model to compare costs of untreated PEM versus nutrition support.
Main Results:
- PEM significantly increases hospital morbidity, mortality, and length of stay (LOS).
- Complications associated with PEM include pneumonia, sepsis, surgical site infections, and delayed wound healing.
- The costs of PEM extend beyond direct medical expenses to include nutrition support and complication management.
Conclusions:
- PEM represents a significant financial burden and a controllable liability for hospitals.
- Early identification and intervention with nutrition support can mitigate costs associated with PEM.
- A comprehensive financial analysis must consider both the costs of intervention and the avoided costs of complications and extended LOS.
Abstract:
PEM or the possibility of developing PEM occurs in 30% to 50% of hospitalized patients, the frequency determined by the criteria used in its assessment and the case mix of patients in the hospital population. This condition exists independently of other medical conditions and results from preadmission or postadmission failure to meet nutrient requirements with associated loss of body weight and function, as well as impaired immunity. PEM also frequently arises in patients with a chronic condition and decreased functional reserve when a superimposed acute metabolic stress leads to accelerated nutrient depletion. Whether preexisting or not, PEM increases morbidity and mortality along with LOS and may be associated with complications such as pneumonia, sepsis, operative site infection, delayed wound healing, or decubitus ulcers. The cost of these complications and an extended LOS is a significant financial burden and a controllable medical liability for hospitals. Other costs include identifying patients at risk of PEM, providing nutrition support, not to mention treating any of its complications (mechanical, metabolic, and so forth). A proper analysis of the financial implications of late or untreated PEM versus nutrition support must therefore take into account not only the costs of complications or extended LOS due to the delay or failure to provide nutrition support but also the costs associated with this intervention itself. In this review, we described a model for examining the financial implications of malnutrition and nutritional therapy.