Malnutrition Quality Improvement Research Articles

The Impact of Malnutrition on Skin Integrity and Wound Healing.

To recognize valuable resources from the Malnutrition Quality Improvement Initiative for acute care patients and malnutrition quality improvement measures for postacute care residents. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Distinguish the prevalence of malnutrition among acute care patients.2. Explain the assessment guidelines for identifying malnutrition.3. Identify the resources available for measuring malnutrition quality improvement.

P04-006-23 Rate and Accuracy of Coded Malnutrition Diagnosis Among Hospitalized Adult Patients Following Implementation of a Malnutrition Quality Improvement Initiative Program

P04-006-23 Rate and Accuracy of Coded Malnutrition Diagnosis Among Hospitalized Adult Patients Following Implementation of a Malnutrition Quality Improvement Initiative Program

The Opportunity for Quality Malnutrition Care to Improve Rural Health Outcomes and Health Equity for Older Americans

Older adults have a heightened risk of malnutrition that occurs with age. Many factors can increase their risk for malnutrition, including factors associated with disease, function, social and mental health, and hunger and food insecurity. Risk for malnutrition is also linked to disparities and may disproportionately impact people living in rural areas. This Perspective paper outlines the issue of malnutrition and its impact on health outcomes and health disparities as well as summarizes existing evidence on malnutrition in rural healthcare institutions. Further it describes opportunities for malnutrition quality improvement and a new malnutrition quality measure, the Global Malnutrition Composite Score measure, that has recently been recommended by the National Quality Forum as a health equity measure for rural healthcare. The Perspective also suggests how this measure may help meet new health equity requirements of the Joint Commission and may help address needs identified in non-profit hospital community health needs assessments. The Perspective identifies resources for malnutrition quality improvement and the Composite measure, and shares key learnings from McPherson Hospital, a rural institution that has worked to improve malnutrition quality care. Finally, the Perspective suggests opportunities for rural healthcare institutions to better connect with community-based nutrition programs/services and recommends where more program development and policy support is still needed.

Reprint of: Development and Evaluation of a Global Malnutrition Composite Score.

Reprint of: Development and Evaluation of a Global Malnutrition Composite Score.

Malnutrition Quality Improvement Initiative Data Support Continued Opportunities in Malnutrition Care.

Malnutrition remains prevalent among hospitalized patients in the United States and is associated with higher morbidity, mortality, and utilization costs when compared with individuals without malnutrition.1-3 Furthermore, estimates that malnutrition affects up to 60% of hospitalized older adults,4 yet continues to go unrecognized or undertreated,5 highlight a need to improve care for this patient population. Quality improvement can play an integral role in generating value-based solutions and provide a path for registered dietitian nutritionists (RDNs) to be at the forefront of improving malnutrition care.

Malnutrition Quality Improvement in Cancer Centers: Moving Beyond Diagnosis

Malnutrition Quality Improvement in Cancer Centers: Moving Beyond Diagnosis

Assessment of hospital malnutrition care practices: The case of a low middle income country.

To improve hospital malnutrition care, assessing actual malnutrition practices and knowledge is essential. Our objectives are to assess malnutrition care practices, evaluate dietitians' malnutrition knowledge, and explore barriers and facilitators to optimal malnutrition care in a LMIC hospitals. This is a national cross-sectional study of mixed-method design. Two questionnaires from the Malnutrition Quality Improvement Initiative were used to assess malnutrition care practices and dietitians' malnutrition knowledge. In-depth interviews were used to investigate barriers and facilitators to optimal malnutrition care. Mean average for malnutrition care practices score was 20.96 out of 30 (N=56). Factors affecting malnutrition practices were: (1) private/public affiliation of the hospital and (2) presence of a documented malnutrition protocol. Dietitians (N=62) working at academic hospitals scored 57% for malnutrition knowledge which was higher than the score for those working at non-academic hospitals (44%). Gaps in malnutrition knowledge among hospital staff, shortage in hospital staff, and lack of financial coverage for nutrition therapy were the main barriers identified from eight in-depth interviews. Efforts should be taken by decision makers to facilitate malnutrition care and increase malnutrition awareness among healthcare professionals.

Malnutrition Quality Improvement Initiative (MQii) Learning Collaborative Institutions Offer Insights on Telehealth Nutrition Services During the COVID-19 Pandemic

Malnutrition Quality Improvement Initiative (MQii) Learning Collaborative Institutions Offer Insights on Telehealth Nutrition Services During the COVID-19 Pandemic

Implementation of malnutrition quality improvement reveals opportunities for better nutrition care delivery for hospitalized patients.

BackgroundGaps in hospital‐based nutrition care practices and opportunities to improve care of patients at risk of malnutrition or malnourished have been demonstrated by several US hospitals implementing quality improvement (QI) projects. This study examined the impact of nutrition care process improvements focused on better documentation of identification and diagnosis of malnutrition in 5 hospital services and differences between nutritionally targeted vs nontargeted services.MethodsData on malnutrition risk screening, nutrition assessment, malnutrition diagnosis, and nutrition care plan delivery were collected from 32,723 hospital encounters for patients admitted to the intensive care unit, pulmonology, oncology, urology, and general medicine services (targeted) as well as the rest of the nontargeted hospital services between 2017 and 2019.ResultsHigher rates of morbidity in targeted service patients compared with those in the patient population admitted in the nontargeted services were observed, including higher rates of malnutrition risk (37.43% vs 19.16%, P < .001), higher rates of moderate and severe malnutrition first identified by a registered dietitian nutritionist (20.27% vs 9.67%, P < .001), and malnutrition diagnosis confirmed by an admitting physician (16.72% vs 6.74%, P < .001).ConclusionsThe findings suggest sustained improvements in confirmed rates of malnutrition identification and diagnosis are achievable. Targeting malnutrition QI efforts to hospital services with higher patient morbidity is an effective method for improving malnutrition diagnosis, in particular in hospitals with limited resources, which in turn can result in improved nutrition care delivery.

Development and Evaluation of a Global Malnutrition Composite Score

Development and Evaluation of a Global Malnutrition Composite Score

Perspectives of Registered Dietitian Nutritionists on Adoption of Telehealth for Nutrition Care during the COVID-19 Pandemic.

Widespread transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a global coronavirus disease 2019 (COVID-19) pandemic that is straining medical resources worldwide. In the United States (US), hospitals and clinics are challenged to accommodate surging patient populations and care needs while preventing further infection spread. Under such conditions, meeting with patients via telehealth technology is a practical way to help maintain meaningful contact while mitigating SARS-CoV-2 transmission. The application of telehealth to nutrition care can, in turn, contribute to better outcomes and lower burdens on healthcare resources. To identify trends in telehealth nutrition care before and during the pandemic, we emailed a 20-question, qualitative, structured survey to approximately 200 registered dietitian nutritionists (RDNs) from hospitals and clinics that have participated in the Malnutrition Quality Improvement Initiative (MQii). RDN respondents reported increased use of telehealth-based care for nutritionally at-risk patients during the pandemic. They suggested that use of such telehealth nutrition programs supported positive patient outcomes, and some of their sites planned to continue the telehealth-based nutrition visits in post-pandemic care. Nutrition care by telehealth technology has the potential to improve care provided by practicing RDNs, such as by reducing no-show rates and increasing retention as well as improving health outcomes for patients. Therefore, we call on healthcare professionals and legislative leaders to implement policy and funding changes that will support improved access to nutrition care via telehealth.

Comprehensive Application of the Malnutrition Quality Improvement Initiative (MQII) Toolkit to Pediatric Malnutrition Care

As pediatric registered dietitian nutritionists (RDNs) make addressing malnutrition a critical part of their nutrition care process (NCP) and integrate malnutrition quality improvement into their health care facilities, they have looked to the Pediatric Nutrition Practice Group (PNPG) for guidance on how to best achieve this goal in the care of infants, children, and adolescents. The Malnutrition Quality Improvement Initiative (MQii) was developed by the Academy of Nutrition and Dietetics (Academy), Avalere Health, and other stakeholders to provide guidance for malnutrition quality improvement efforts through key technical expert and advisory roles.

Improving Nutrition Care Processes and 30-day Readmissions Through Malnutrition Quality Improvement Initiatives

Improving Nutrition Care Processes and 30-day Readmissions Through Malnutrition Quality Improvement Initiatives

Opportunities for Quality Improvement Programs (QIPs) in the Nutrition Support of Patients with Cancer.

Malnutrition in patients with cancer is a ubiquitous but neglected problem that can reduce patient survival/quality of life and increase treatment interruptions, readmission rates, and healthcare costs. Malnutrition interventions, including nutrition support through dietary counseling, diet fortification, oral nutrition supplements (ONS), and enteral and parenteral nutrition can help improve health outcomes. However, nutritional care standards and interventions for cancer are ambiguous and inconsistently applied. The lack of systematic malnutrition screening and intervention in ambulatory cancer care has especially significant consequences and thus the nutrition support of patients with cancer represents an area for quality improvement. United States healthcare payment models such as the Oncology Care Model are linked to quality of care and health outcomes. Quality improvement programs (QIPs) can advance patient-centered care, perfect care processes, and help healthcare professionals meet their quality measure performance goals. Malnutrition QIPs like the Malnutrition Quality Improvement Initiative (MQii) have been shown to be effective in identifying and treating malnutrition. However, little is known about or has been reported on nutrition or malnutrition-focused QIPs in cancer care. This paper provides information to support translational research on quality improvement and outlines the gaps and potential opportunities for QIPs in the nutrition support of patients with cancer.

Differences in Nutrition Interventions Among Malnourished Hospitalized Patients

Abstract Objectives This study examined how nutrition intervention approach and utilization rate varied by the method of malnutrition risk documentation. Methods 16,669 hospital patient records collected from 4 US hospital systems from January–June 2019 as part of the Malnutrition Quality Improvement Initiative (MQii) Learning Collaborative were analyzed. Nutrition interventions included: enteral nutrition, parenteral nutrition, ONS, feeding assistance, food and nutrition related medical management, nutrition education, counseling, and care coordination. Results Similar numbers of patients were documented as malnourished by nutrition assessment (n = 1087) and medical diagnosis (n = 1186). Only 46% (n = 692) of patients documented as malnourished by assessment or diagnosis received a nutrition intervention. The most frequently used interventions were ONS (n = 854), nutrition education (n = 318), and care coordination (n = 290). 53.1% of patients who received a nutrition intervention received multiple nutrition interventions; the average number of interventions was 2.03. Patients with a physician diagnosis of malnutrition more frequently received parenteral and enteral nutrition (7.75% vs 1.78%, P = 0.0191, and 26.36% vs 7.69%, P &amp;lt; 0.0001, respectively), while patients with malnutrition documented by a registered dietitian more frequently received ONS (82.84% vs 58.14%, P &amp;lt; 0.0001) and counseling (52.66% vs 1.55%, P &amp;lt; 0.0001). Conclusions Utilization of nutrition interventions for patients documented by nutrition assessment and medical diagnosis are quite similar, suggesting a positive level of care coordination exist. Differences in intervention utilization rate and approach are consistent with previous literature showing that physicians diagnose and treat more severely malnourished patients, often through enteral and parenteral nutrition. Future work is needed to investigate the impact of each intervention type separately and combined on patient health and economic outcomes. Funding Sources The MQii is a project of the Academy of Nutrition and Dietetics, Avalere Health, and hospital stakeholders who participated in the collaborative partnership. Abbott provided financial support for MQii development and application.

How a Malnutrition Quality Improvement Initiative Furthers Malnutrition Measurement and Care: Results From a Hospital Learning Collaborative.

BackgroundMalnutrition in hospitalized patients can adversely affect health outcomes and increase the cost of care. Real‐world strategies are needed for prompt identification and treatment of patients at risk of malnutrition.ObjectivesThe aim of this quality improvement (QI) study was to measure the impact of a nutrition‐focused program on the malnutrition care processes of participating hospitals. Secondary objectives were to determine whether improvements in these nutrition‐related processes reduced hospital readmissions and length of stay (LOS) in patients ≥65 years.MethodsA group of 27 US hospitals (“The Collaborative”) implemented the Malnutrition Quality Improvement Initiative (MQii), as guided by a Malnutrition QI Toolkit and 4 electronic clinical quality measures (eCQMs), including (1) nutrition screening; (2) nutrition assessment following detection of malnutrition risk; (3) nutrition care plan for patients identified as malnourished after completed nutrition assessment; and (4) documentation of malnutrition diagnoses. Multivariate analyses identified the variables best correlated with patient outcomes.ResultsImprovements were observed for all 4 eCQMs. The greatest improvements were achieved as a result of timely nutrition assessment (P = .06) and malnutrition diagnosis (P = .02). Patients ≥65 years with a malnutrition diagnosis and nutrition care plan had a 24% lower likelihood of 30‐day readmission but a longer mean LOS than did those without a care plan.ConclusionsIn this study, the implementation of MQii practices significantly improved the identification of malnutrition. The prompt identification and treatment of patients at malnutrition risk can improve patient care and health, as well as reduce costly readmissions.

Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital

As many as 50% of hospitalised patients are estimated to be malnourished or at risk of malnutrition on hospital admission, but this condition often goes unrecognised, undiagnosed and untreated. Malnutrition...

A Malnutrition Quality Improvement Project: Investigating Use of the PIECES™ Score as a Secondary Malnutrition Screening Tool

Upon completion, the participant will be able to describe the effectiveness of a readmission risk predictor, Pieces™, as a secondary nutrition screening for malnutrition identification in an acute care hospital.

Engagement of the Academy’s Dietetic Practice Groups with MQii

Raise awareness of Malnutrition Quality Improvement Initiative (MQii) efforts and recruitment in the Learning Collaborative among the Academy’s Dietetic Practice Groups (DPGs). As efforts of the Malnutrition Quality Improvement Initiative (MQii) were underway it became apparent to MQii Partners, Academy of Nutrition and Dietetics and Avalere Health, that engagement with the Academy’s DPG Leaders is critical in order to advance objectives of the initiative which include:Advance adoption of malnutrition electronic clinical quality measures (eCQMs);Improve effectiveness and timeliness of malnutrition care through an interdisciplinary toolkit; andSupport availability of tools that can be integrated into EHR systems to improve care quality. Three major strategies were identified and operationalized to advance the noted objectives. First, a Lunch and Learn event was held for DPG Leaders at the Food & Nutrition Conference & Expo™ (FNCE) 2017 to brief them on current MQii activities. Second, a series of MQii follow-up webinars with DPG leaders got underway in order to provide MQii updates and provide opportunity for attendees to ask questions. Lastly, a Malnutrition Quality Improvement survey was deployed to 26 DPG memberships to gain member interest level with participation in the MQii Learning Collaborative. Over 100 participants attended the MQii Lunch and Learn event at FNCE Chicago 2017. Attendees received a customized malnutrition communication packet to share with their DPG membership focusing on how to get started using malnutrition eCQMs, obtaining C-suite and clinical care team support, and overcoming barriers. Four separate DPG engagement webinars occurred from February to March 2018. During the webinars DPG leaders were updated on MQii progress and engaged in a discussion to share their insights on where their memberships have opportunities to be involved with MQii. The Malnutrition Quality Improvement survey indicated that 20% of respondents were interested in participating in the MQii Learning Collaborative. DPGs play a unique role of facilitating dietetic practitioners to connect with fellow like-minded colleagues. Targeting the 26 DPGs allowed the Academy to significantly increase recruitment efforts for the MQii Learning Collaborative. A total of 119 adult in-patient acute-care hospitals expressed interest in joining the MQii Learning Collaborative.

Quality Improvement as the Foundation for Health Care Advancement

The rising cost of health care continues to be a key driver of the growing national debt. Improving the nation’s health requires a dedicated and holistic advancement of access to quality and affordable patient-centered health care, as well as a strong focus on the core elements of prevention, including nutrition. Programs must be put in place, such as the Malnutrition Quality Improvement Initiative (MQii), to identify and address the root causes of malnutrition. Registered dietitian nutritionists have an important role to lead malnutrition quality improvement efforts in their organizations to promote better patient health outcomes, keep health care costs affordable, and protect Medicare. It is a unique time where there is an opportunity to achieve meaningful change in malnutrition care, and working together to implement quality improvement programs can ensure the health and vitality of current and future generations of Americans. Funding/SupportPublication of this supplement was supported by Abbott. The Academy of Nutrition and Dietetics does not receive funding for the MQii. Avalere Health's work to support the MQii was funded by Abbott.