Two other categories of malnutrition have mushroomed as well. ICD-9 261 indicating care for a protein deficiency called marasmus, bloomed from 37,288 cases in 2007 to 103,132 in 2009. Moreover ICD-9 262 – other severe malnutrition cases – went from 22,680 to 114,417.
Asked why these cases are ballooning, Ann Elexhauser, an AHRQ senior research scientist, said in an interview Monday she was unaware of the phenomenon review is being launched.
Ted Mazer, MD, a physician on staff at Alvarado Hospital Medical Center in San Diego, which Prime purchased last fall, hypothesized that the upswing may be tied to better surveillance for disease at the time of admission. Or, he says, "it might be due to administrative policies that automatically require albumin levels in routine daily blood draws. The former is good care if it is followed by intervention directed to such malnutrition.
"Albumin below a certain level may be associated with malnutrition, such as at time of admission, but it may also be a transient and expected effect of medical or surgical care of a problem unrelated to malnutrition, from which the patient is expected to recover once regular nutrition is restarted," says Mazer, former president of the San Diego County Medical Society.
"Let's say you're randomly or routinely including albumin levels for certain patients in your blood draws. At some point, you may reach the critical level that meets the criteria for kwashiorkor, or malnutrition, even though it's iatrogenic. You can say, 'Oh, the patient now has a technical characteristic of possible kwashiorkor diagnosis, so we're going to use that as the diagnosis for their stay.' "