Malnutrition Diagnosis during Adult Inpatient Hospitalizations: Analysis of a Multi-Institutional Collaborative Database of Academic Medical Centers

Abstract

Background: Malnutrition is a significant problem for hospitalized patients. However, the true prevalence of reported malnutrition diagnosis in real-world clinical practice is largely unknown. Using a large collaborative multi-institutional database, the rate of malnutrition diagnosis was assessed and used to assess institutional variables associated with higher rates of malnutrition diagnosis.

Objective: The aim of this study was to define the prevalence of malnutrition diagnosis reported among inpatient hospitalizations.

Design: The University Health System Consortium (Vizient) database was retrospectively reviewed for reported rates of malnutrition diagnosis.

Participants/setting: All adult inpatient hospitalization at 105 member institutions during fiscal years 2014 and 2015 were evaluated.

Main outcome measures: Malnutrition diagnosis based on the presence of an International Classification of Diseases-Ninth Revision diagnosis code.

Statistical analysis: Hospital volume and publicly available hospital rankings and patient satisfaction scores were obtained. Multiple regression analysis was performed to assess the association between these variables and reported rates of malnutrition.

Results: A total of 5,896,792 hospitalizations were identified from 105 institutions during the 2-year period. It was found that 292,754 patients (5.0%) had a malnutrition diagnosis during their hospital stay. By institution, median rate of malnutrition diagnosis during hospitalization was 4.0%, whereas the rate of severe malnutrition diagnosis was 0.9%. There was a statistically significant increase in malnutrition diagnosis from 4.0% to 4.9% between 2014 and 2015 (P<0.01). Institutional factors associated with increased diagnosis of malnutrition were higher hospital volume, hospital ranking, and patient satisfaction scores (P<0.01).

Conclusions: Missing a malnutrition diagnosis appears to be a universal issue because the rate of malnutrition diagnosis was consistently low across academic medical centers. Institutional variables were associated with the prevalence of malnutrition diagnosis, which suggests that institutional culture influences malnutrition diagnosis. Quality improvement efforts aimed at improved structure and process appear to be needed to improve the identification of malnutrition.

Keywords: Clinical documentation; Diagnosis; Malnutrition; Patient satisfaction; Quality improvement.