RESUMEN
The purpose of value-based healthcare is to effectively control medical costs on the basis of comprehensively improved healthcare quality, which is the key focus of medical system reform in China. Improving information system framework, establishing scientific evaluation methods and transforming medical insurance payment methods are the impetus for value-based healthcare practice in China. "Screening, assessment and intervention" is the critical step in standardized medical nutrition management. In line with the connotation of value-based healthcare, nutritional risk screening aims to improve clinical outcomes. The diagnosis of malnutrition per the Global Leadership Initiative on Malnutrition (GLIM) criteria enables the inclusion into Diagnosis Related Groups (DRGs). Oral nutritional supplement is the preferred medical nutrition treatment for patients at nutritional risk or with malnutrition and insufficient food intake. Standardized application can reduce weight loss, improve clinical outcomes, save medical costs and improve the health and survival of malnourished elderly patients at a lower cost, exemplifying the value-based healthcare model.
RESUMEN
In the 42 nd and 44 th workshops of CSPEN-nutritional risk-undernutrition-support-outcome-cost effectiveness ratio (NUSOC) multi-center database collaboration group, Jens Kondrup and Henrik Rasmussen described again the application of NRS 2002, the evidence-based basis of NRS 2002 development and the methodology for prospective validation of clinical effectiveness. There is no gold standard for validation. They both considered that malnutrition could be identified as a score of 3 or more for impaired nutritional status in NRS 2002. Although NRS 2002 is simple and easy to be applied, it is not comprehensive enough for malnutrition diagnosis. ASPEN and ESPEN on-line published the Global Leadership (nutritional) Initiative on Malnutrition(GLIM)diagnosis criteria in September 2018. With the gradual implementation of medicare payment based on diagnosis related groups(DRG)in China, the nutritional risk and the malnutrition diagnosis with Chinese version of ICD-10 (2016) code should be recorded in the first page of the medical records. In this terminology interpretations, the terms of nutritional risk screening(NRS 2002.01.016)and malnutrition diagnosis (GLIM-phenotypic criteria 01.028, etiologic criteria 01.029) published in Parenteral and Enteral Nutrition Terminology 2019 are discussed based on the reports given by Kondrup and Rasmussen in Beijing and Zhengzhou.
RESUMEN
La valoración del estado nutricional constituye un aspecto clave en la atención de la población adulta mayor, aunque no existe una herramienta de referencia que permita definir de forma inequívoca la situación nutricional de un paciente, la intervención nutricional a través del diagnóstico-planificación-acción-evaluación, mejora la calidad de vida y garantiza la salud. Con el propósito de realizar diagnostico nutricional de 66 adultos mayores, que se encuentran viviendo en un centro geriátrico de larga estancia de Caracas, se elaboró y aplicó un formato de historia nutricional que incluiría la encuesta MNA y otros parámetros de interés. Este instrumento detectó de forma rápida, sencilla, económica y poco invasiva 25,76% casos de malnutrición y 40,91% riesgo de malnutrición en los evaluados, así como las posibles condiciones que las generan como demencia senil tipo Alzheimer, hipertensión arterial que requiere polimedicación y discapacidad motora. La evaluación antropométrica permitió detectar que el 70,59% de la malnutrición es de tipo calórica protéica. La dificultad para vivir sólos, el envejecimiento y la poca ingesta de alimentos, especialmente de aceite de oliva y frutos secos, influyen en el deterioro de la salud de estos pacientes. Un IMC promedio inferior a 23 kg/m² y la circunferencia de pantorrilla inferior a 31cm, demuestran un socavado estado nutricional y un déficit protéico. La información obtenida, permitió realizar un informe nutricional individualizado que se incluyó en la historia médica de cada paciente, que podrían ser utilizada en un futuro para realizar cambios al menú, recomendaciones, suplementación e interconsultas médicas a quienes requirieran mayor intervención de acuerdo a cada caso.
The assessment of nutritional status is a key aspect in the care of older adults, although there is no reference tool that can unmistakenly define the nutritional status of a patient, nutritional intervention through diagnosis-planning-actionevaluation improves the quality of life and guarantees health. In order to perform nutritional diagnosis to 66 older adults, who are living in a long stay nursing home in Caracas, a format of nutritional history was developed and applied, which included the MNA survey and other factors of interest. This method detected in a quick, simple, inexpensive and minimally invasive manner 25.76% cases of malnutrition and 40.91% cases of malnutrition at risk within the assessed, as well as the possible conditions that generate them such as senile dementia (Alzheimers type), high blood pressure which requires multiple medication, and motor disabilities. The anthropometric assessment allowed us to detect that 70.59% of malnutrition is of a protein calorie kind. The difficulty of living alone, aging and a low intake of food, particularly olive oil and nuts, influence the deteriorating health of these patients. An average BMI below 23 kg/m² and the circumference of less than 31cm calf, show an undercut nutritional status and a protein deficit. The information obtained allowed an individualized nutritional report that was included in the medical history of each patient, one which could be used in the future to make changes to the menu, to give recommendations, supplementation and medical interconsultations to those who require greater intervention according to each case.