Malnourished patients compose 25% to 54% of the admitted patient population. Much attention has been given to identifying these malnourished patients. However, few published articles have focused on identifying the gaps in care that follow a malnutrition diagnosis and their effects on length of stay and readmission. We aimed to describe the prevalence of these gaps in care and their system level components. We hypothesized that length of stay and readmission were associated with these gaps in care.
We conducted a retrospective case study of 242 adult patients (>18 years old) who were admitted to a medicine unit at New York Presbyterian- Weill Cornell hospital from September 1- November 30, 2014. Patient charts were identified through Humedica with ICD 9 codes for either severe or non-severe malnutrition. Two registered dieticians reviewed each chart to determine the system level gap in care: communication, test delay, or discharge planning. Wilcoxon rank-sum was used to evaluate continuous variables. Fisher’s exact and chi-square tests were used to evaluate categorical variables. Logistic regression was used to assess an association between each gap in care and readmission as well as length of stay, adjusting for age, gender, malnutrition severity and malnutrition context.
76.5% of malnourished patients had a gap in care. Discharge planning, testing delay and communication related gaps composed 68.1 %, 26.4%, and 13.2% of malnourished patients respectively. For each day increase in length of stay the odds of any gap was significantly higher adjusting for the characteristics above (OR: 1.12, 95% CI: 1.04-1.21, p-value=0.003). Similarly, for each day increase in length of stay, the odds of having a testing gap or communication gap was significant higher (OR: 1.11 95% CI: 1.06-1.15, p-value<0.001; OR: 1.06, 95% CI: 1.02-1.11, p-value=0.002, respectively). For each year increase in age, the odds of having a testing gap was significantly lower (OR: 0 .98 95% CI: 0.96-0 .99, p-value= 0.041). However for each year increase in age, the odds of having a discharge gap trended higher; OR: 1.02 95% CI: 1.00-1.03, p-value=0.077). Female patients were 4.12 times significantly more likely to have a communication gap compared to males adjusting for readmission, length of stay, age, malnutrition severity and malnutrition context (OR: 4.12 95% CI: 1.65-10.26, p-value= 0.002). Readmission for gaps in care ranged from 34-39% but was not statistically significant.
Conclusions: Readmission was not found to be statistically significant however gaps in care attributed to a 20% readmission rate. Furthermore, any gap in care was associated with a 6-12% greater odds of a longer length of stay. As 76.5% of malnourished patients have a gap in care, research and interventions focusing on mitigating these gaps are needed to better patient care, shorten length of stay and prevent re-admission.
To cite this abstract:Gupta, R; Chambers, R; Russo, E; Bryan, J; Jannat-Khah, DP; Merriman, L . IDENTIFYING GAPS IN CARE OF MALNOURISHED PATIENTS AND THE EFFECTS ON LENGTH OF STAY AND READMISSION IN AN ACUTE CARE SETTING. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 80. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/identifying-gaps-in-care-of-malnourished-patients-and-the-effects-on-length-of-stay-and-readmission-in-an-acute-care-setting/. Accessed April 9, 2020.