Graduation Date

Spring 5-7-2016

Document Type

Thesis

Degree Name

Master of Science (MS)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Corrine Hanson, PhD, RD, LMNT

Abstract

Background: Malnutrition is present in 25-50% of hospitalized patients. Patients identified as malnourished are assigned a code based on the type and severity of malnutrition in order to gain the necessary reimbursement to care for the patients. There is a current gap in the research regarding the characteristics that define the difference between malnourished patients classified with a major complications and comorbidities (MCC) code versus a complications and comorbidities (CC) code.

Purpose: The purpose of this study was to determine which malnutrition codes are being used at Nebraska Medicine. Additionally, this study obtained clinical factors that are associated with malnutrition to determine how/if these factors differ between categories of reimbursement.

Methods: The malnutrition code used during admission and the reimbursement category the codes belonged to was collected for 923 subjects. In a subset of 200 subjects, admission, discharge, demographic and anthropometric data were collected and analyzed. All data were collected at two time points for each subject: at admission and at discharge.

Results: Six out of a possible eight malnutrition codes were used. Out of 923 subjects, 67.4% were classified with malnutrition codes that are within the CC reimbursement category. Percent of ideal body weight (IBW), body mass index (BMI), and albumin differed significantly between the MCC and CC groups when categorized based on severity criteria. The odds of being classified with a MCC code are 3.5 times higher for subjects who presented with muscle mass loss at admission, and 2.2 times higher for subjects who had muscle mass loss at discharge.

Conclusion: Both MCC and CC malnutrition codes are utilized at Nebraska Medicine. Muscle mass loss, both at admission and at discharge significantly increased the odds of a subject being classified with a MCC malnutrition code. Malnourished patients are being classified as MCC or CC based on the criteria currently being taught at Nebraska Medicine.