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Malnutrition ‘self-screening’ with ‘MUST’ in hospital outpatients predicts health-care outcomes

Published online by Cambridge University Press:  08 April 2011

A. L. Cawood ,
R. J. Stratton ,
S. Rust ,
E. Walters  and
M. Elia
A. L. Cawood
Affiliation:
Medical Affairs, Nutricia Ltd, Wiltshire BA14 0XQ, UK
R. J. Stratton
Affiliation:
Medical Affairs, Nutricia Ltd, Wiltshire BA14 0XQ, UK Institute of Human Nutrition, University of Southampton, SO16 6YD, UK
S. Rust
Affiliation:
Nutrition and Dietetic Department, Southampton General Hospital, SO16 6YD, UK
E. Walters
Affiliation:
Nutrition and Dietetic Department, Southampton General Hospital, SO16 6YD, UK
M. Elia
Affiliation:
Institute of Human Nutrition, University of Southampton, SO16 6YD, UK
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Abstract

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Proceedings of the Nutrition Society , Volume 69 , Issue OCE7: Malnutrition Matters, Joint BAPEN and Nutrition Society Meeting, 2nd and 3rd November 2010, Harrogate , 2010 , E566
Copyright
Copyright © The Authors 2011

Patients ‘self-screening’ using a patient friendly ‘Malnutrition Universal Screening Tool’ (‘MUST’) has recently been investigated in hospital outpatient clinics and shown to have concurrent validity with trained health-care professional screening(Reference Stratton1). The extent to which ‘self-screening’ can predict health outcomes and use of health-care resources is unknown. The aim of this study was to investigate the predictive validity of outpatients ‘self-screening’ with ‘MUST’.

The study involved 205 patients (mean age 55 (SD 17) years; 56% male) randomly recruited from gastroenterology (40%) and non-gastroenterology clinics (60%), who screened themselves for malnutrition risk (80.5% at low risk, and 19.6% at medium+high risk). Health-care use was collected prospectively from electronic records during the subsequent 6 months (hospital admissions, length of hospital stay (LOS) and outpatient appointments (OP)).

Outpatients at risk of malnutrition from ‘self-screening’ with ‘MUST’ experienced significantly more hospital admissions (including emergency admissions), significantly more outpatient appointments and had longer hospital stays (table). When adjusted for age, sex and type of clinic (gastroenterology v. non-gastroenterology), length of hospital stay became significant, admissions and outpatient appointments remained significant.

Mean±SD; #Chi2

* ANOVA, med=medium. When adjusted for age, sex and type of clinic, mean results remain the same but significance increases (number of hospital admissions P=0.007; LOS P=0.037).

The average cost for hospital admissions(Reference Curtis2) per patient in the whole group was significantly greater (115%) for the patients at medium+high risk of malnutrition compared to low risk (£2357±£2999 v. £1096±£2900).

This study shows that ‘self-screening’ for malnutrition (medium+high risk according to ‘MUST’) predicts increased resource use (predictive validity) with important health economic implications. Similar predictive validity results have been found in studies of health-care professionals' screening of inpatients(Reference Stratton3) and outpatients(Reference Cawood4).

References

1.Stratton, RJ et al. (2010) Proc Nutr Soc (submitted abstract).Google Scholar
2.Curtis, L (2009) Unit Costs of Health and Social Care 2009. http://www.pssru.ac.ukGoogle Scholar
3.Stratton, RJ et al. (2006) Br J Nutr 95, 325–330.CrossRefGoogle Scholar
4.Cawood, AL et al. (2010) Proc Nutr Soc 69, OCE2, E149.Google Scholar
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