The Application of CQI Principles to Services:: The Case for Hospitalized Patients at Risk for Malnutrition

Abstract

A multidisciplinary, malnutrition treatment program was developed and implemented at a 395-bed, community hospital to reduce delays in initiating and achieving a therapeutic level of nutrition care for patients identified to have a significant risk for malnutrition (13% of the adult patient population). The project contained a continuous quality improvement (CQI) plan that assessed the effectiveness of the treatment program to achieve these goals. An outcome study was designed to evaluate the impact of nutrition interventions on patient recovery and cost of care. To quantify the impact, the study compared the patient population at high risk for malnutrition both before and after implementation of a malnutrition clinical pathway. Albumin, functional status, and the use of nutrition support (enteral or parenteral) were the variables used to predict outcomes such as length of stay (LOS), discharge disposition and the number of complications. The study required the data sets to be examined and normalized for severity of illness using scaled values of serum albumin. The scaling produced three classes which identified the study population by serum albumin value: (1) >2.7 g/dl, (2) 2.3-2.7 g/dl, and (3) <2.3 g/dl. A cost avoidance of $930,000 was calculated from the reduction of complications when comparable severity of illness between the study groups was considered. Similarly, a $1,008,000 cost avoidance was projected when calculations were made from the reduction in LOS. The application of CQI principles to nutrition care services improved clinical care and clinical effectiveness. The program established a model to effectively allocate existing resources to provide timely and therapeutic nutrition interventions to patients at high risk for malnutrition. A method for the ongoing collection of outcome data has been incorporated into the routine course of nutrition care. This allows for more efficient and frequent performance reviews and CQI.