The Malnutrition Quality Improvement Initiative (MQii) is a multi-year effort that began in 2013 when a variety of stakeholder organizations began to highlight gaps in existing malnutrition care and the impact of these gaps on patient outcomes. Based on the results of subsequent literature reviews, landscape assessments, engagements with key stakeholders, and best practices research, the MQii was established in partnership with the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders providing guidance through key technical expert and advisory roles. The engagement was undertaken to advance evidence-based, high-quality patient-driven care for hospitalized older adults (age 65 and older) who are malnourished or at-risk for malnutrition. Support for the MQii was provided by Abbott.
The MQii places the patient at the center of the quality improvement process and uses widely-accepted quality improvement practices to support healthcare organizations in achieving better malnutrition quality of care. Such established practices and models include Plan-Do-Study-Act, LEAN, and Six Sigma.
The Toolkit is a collection of evidence-based malnutrition care best practices and resources and is intended for use by all members of the care team (e.g., nurses, dietitians, physicians, patients and caregivers) who engage in care for older adult patients who are malnourished or at risk of malnutrition. By using this Toolkit to support quality improvement (QI), healthcare institutions may be able to:
The MQii Toolkit was tested over a three-month implementation period in 2016 through a multi-site Demonstration and Learning Collaborative. The Toolkit’s use demonstrated that the introduction of recommended malnutrition quality improvement actions helps healthcare institutions achieve performance goals in nutrition care.
The MQii Toolkit and the accompanying Tools and Resources are provided here for your use to help you implement this initiative in your own hospital(s). As you use the MQii Toolkit to achieve malnutrition standards of care, you can evaluate the impact of your quality improvement project using a set of malnutrition electronic clinical quality measures (additional information provided below). Please explore the resources and information provided through the Toolkit to see how this initiative can help advance malnutrition care where you work.
The Academy of Nutrition and Dietetics and Avalere developed and tested a set of four malnutrition eCQMs throughout 2015-2016. The four eCQMs are:
Building upon these four foundational measures, the Academy and Avalere have also developed a malnutrition composite measure. This measure intends to evaluate whether evidence-based care takes place throughout the malnutrition clinical workflow. The malnutrition composite measure is currently under review by the Centers for Medicare & Medicaid Services (CMS) for proposed adoption into the Hospital Inpatient Quality Reporting Program.
In 2020, the Premier Clinician Performance Registry and the U.S. Wound Registry have each adopted two measures for outpatient reporting by dietitians and physicians participating in the MIPS program.
In 2016, the Academy and Avalere established the MQii Learning Collaborative. This Collaborative brings together leading hospitals and health systems across the U.S. to support acceleration and dissemination of malnutrition best practices for patients. Learning Collaborative participants undertake a data-driven, patient-centered, malnutrition quality improvement project at their respective institutions using a best practices Toolkit, and are encouraged to use the malnutrition eCQMs to track and monitor improvement. The figure below highlights this dual-pronged approach, whereby healthcare institutions can more rapidly and effectively achieve malnutrition care standards through joint use of these tools.
In 2017, 50 hospitals across the United States participated in the Learning Collaborative and showed meaningful improvements in the delivery of malnutrition care. In 2018, the Learning Collaborative expanded to demonstrate the scalability of these activities in a diverse array of healthcare institutions throughout the United States and beyond. In addition, the Academy and Avalere are working with Learning Collaborative participants to explore opportunities to better screen for and provide care to malnourished patients and patients at risk of malnutrition as they transition across care settings. Should you be interested in learning more about the Learning Collaborative or how you can get involved, please click here.
"I encourage everyone to take the next right step and begin a Malnutrition Quality Improvement Initiative in your organization… You will not regret going on this journey."
Click here to view all Learning Collaborative participant quotes.