Decisions are used by organizations to manage and execute their coordinated, value-adding decision-making and are thereby among an organization’s most important assets. To be able to manage deci-sions and underlying business rules, Decision Management (DM) and Business Rules Management (BRM) are increasingly being applied at organisations. One of the latest developments related to the domain of DM and BRM is the introduction of the Decision Model and Notation (DMN) in September 2015 by the Object Management Group (OMG). The goal of this technical paper is to provide students with a case to practice the specification, verification, validation, deployment, execution, monitoring and governance of business rules in practice.
Objectives: The aim of this study was to determine how diagnosing and coding of malnutrition in an internal medicine ward setting influences potential hospital reimbursement. Methods: Patients admitted to the internal medicine ward of Centro Hospitalar do Médio Ave between April 24 and May 22, 2018 were screened by Nutritional Risk Screening 2002, and patients classified as at “risk for malnutrition” were assessed by the Patient-Generated Subjective Global Assessment (PG-SGA). For each patient, medical coders simulated coding, taking into account the malnutrition diagnosis by PG-SGA, and compared it with the real coding as retrieved from the medical records. For the coding, the Diagnosis-Related Group and Severity of Illness were determined, allowing the calculation of hospitalization cost (HC) according to Portuguese Ministerial Directive number 207/2017. The increase of HC in this subsample was extrapolated to the number of patients admitted during 2018, to obtain the estimated unreported annual HC. Results: Of the 71% (92/129) participants having malnutrition risk according to Nutritional Risk Screening 2002, 86% were malnourished. Including malnutrition diagnosis in the coding of malnourished patients increased the level of Severity of Illness in 39% of cases and increased HC for this subsample, resulting in €52 000. Extrapolating for the annual HC, total HC reached €1.3 million. Conclusions: Identifying malnourished patients and including this highly prevalent diagnosis in medical records allows malnutrition coding and consequent increase of HC. This can improve the potential hospital reimbursement, which could contribute to the quality of patient care and economic sustainability of hospitals.
Objectives: Malnutrition is associated with a twofold higher risk of dying in patients with tuberculosis (TB) and considered an important potentially reversible risk factor for failure of TB treatment. The construct of malnutrition has three domains: intake or uptake of nutrition; body composition and physical and cognitive function. The objectives of this systematic review are to identify malnutrition assessment methods, and to quantify how malnutrition assessment methods capture the international consensus definition for malnutrition, in patients with TB.Design: Different assessment methods were identified. We determined the extent of capturing of the three domains of malnutrition, that is, intake or uptake of nutrition, body composition and physical and cognitive function.Results: Seventeen malnutrition assessment methods were identified in 69 included studies. In 53/69 (77%) of studies, body mass index was used as the only malnutrition assessment method. Three out of 69 studies (4%) used a method that captured all three domains of malnutrition.Conclusions: Our study focused on published articles. Implementation of new criteria takes time, which may take longer than the period covered by this review. Most patients with TB are assessed for only one aspect of the conceptual definition of malnutrition. The use of international consensus criteria is recommended to establish uniform diagnostics and treatment of malnutrition.
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