title: [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].
abstract: 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.
  
  
  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.
authors: Sección Endocrinología y Nutrición, Hospital San Pedro de Alcántara, Cáceres.. jesusmoranlopez@yahoo.es.
authors: Jesús Manuel
authors: JM
authors: Morán López
authors: Sección Endocrinología y Nutrición, Hospital San Pedro de Alcántara, Cáceres.. jesusmoranlopez@yahoo.es.
authors: Fidel Jesús
authors: FJ
authors: Enciso Izquierdo
authors: Unidad de Codificación, Hospital San Pedro de Alcántara, Cáceres.. jesusmoranlopez@yahoo.es.
authors: Belén
authors: B
authors: Beneítez Moralejo
authors: Unidad de Soporte Nutricional, Hospital Infanta Cristina, Badajoz.. jesusmoranlopez@yahoo.es.
authors: Luis Miguel
authors: LM
authors: Luengo Pérez
authors: Sección de Endocrinología y Nutrición, Hospital Valdecilla, Santander. España.. jesusmoranlopez@yahoo.es.
authors: María
authors: M
authors: Piedra León
authors: Sección de Endocrinología y Nutrición, Hospital Valdecilla, Santander. España.. jesusmoranlopez@yahoo.es.
authors: José Antonio
authors: JA
authors: Amado Señaris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004704:Endocrinology; D005260:Female; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000191:economics / Q000628:therapy*; D008875:Middle Aged; D044623:Nutrition Therapy / Q000191:economics*; D052756:Nutritional Sciences; D010351:Patient Discharge