Nutrition and Quality: Value of the GMCS

Nutrition and Quality:  Value of the GMCS  

Studies present evidence that nutrition is a foundational component of recovery from acute conditions and impacts overall patient well-being. Malnutrition is associated with longer hospital stays, higher readmission rates, and poorer clinical outcomes. High-quality patient care that addresses patients’ nutritional needs contributes to reduced complications, improved recovery and healing, enhanced patient experience and satisfaction, and lower healthcare costs. The adoption of the Global Malnutrition Composite Score (GMCS) into the hospital quality reporting program represents an important step forward in recognizing the importance of measuring the nutrition care processes (screening, assessment, diagnosis, care plan) in the hospital setting.  But nutrition impacts multiple aspects of patient-centered care  elevating the value of the GMCS, including other measures of  hospital  quality performance, recovery in the post-acute setting, and prevention and management of chronic conditions in the ambulatory setting. With the growing recognition of the value of nutrition care in driving overall health system quality performance, integrating nutrition into hospital-wide quality initiatives is more important than ever. 

The Role of Nutrition in High-Quality, Patient-Centered Hospital Care 

Hospitals are accountable for performance on multiple measures of quality  supported by the GMCS, many of which can be directly impacted by nutrition interventions. Several electronic Clinical Quality Measures (eCQMs) in the Hospital Inpatient Quality Reporting (IQR) Program highlight this connection. The Hospital Harm: Pressure Injury eCQM and associated claims-based patient safety indicator benefit from early nutrition intervention to support skin integrity. Hospital Harm: Falls with Injury and the fall-associated fracture rate, key measures of patient safety in the hospital, are influenced by nutrition’s role in maintaining muscle strength and reducing frailty. The Hospital Harm: Severe Hyperglycemia and Severe Hypoglycemia measures can be improved through  monitoring meal times and nutrition interventions. The medical and surgical care associated with the acute care stay can make timing of meals variable, and create delays in eating such as NPO status or new medications can impact blood glucose levels. Beyond the eCQMs, other hospital quality initiatives such as the Age-Friendly Hospital structural measure leverages nutrition processes to prevent functional decline in older adults. The Screening for Social Drivers of Health structural measure requires the hospital to screen for food insecurity and promotes evidence-based interventions to address unmet food needs before discharge. By aligning nutrition-focused QI initiatives with these measures, hospitals can enhance patient outcomes and overall hospital quality performance. In future blog posts we’ll explore these measures and how nutrition care can be integrated into improvement plans. 

Embedding Nutrition in Quality Improvement Across the Care Continuum 

The nutrition care process in the hospital setting as measured by the GMCS sets patients on the right path for improved nutritional status.  While the GMCS only quantifies how that care is delivered in the inpatient setting, the established care plan should be carried over into the next site of care – whether that is an inpatient post-acute facility, home health, or the physician office – by communicating across care teams and ensuring that key nutrition information isn’t lost during the transition of care.  And while establishing optimal nutrition-focused care transition plans within integrated health systems is made easier through common IT systems and communication channels, similar improvement initiatives can be undertaken between unaffiliated hospitals and the receiving post-acute and ambulatory networks by bringing the right stakeholders together to rally around the common goal of improved patient care.  Establishing a multidisciplinary team, including dietitians, nurses, physicians, facility leaders, and care managers, ensures coordinated implementation. For more information on getting started with QI, visit the Malnutrition Quality Improvement Initiative QI page. 

Evidence and Policy Trends 

CMS has continued to encourage adoption and use of quality measures that reflect the importance of nutrition in healthcare delivery. One of the most notable advancements is the expansion of the GMCS population from adults aged 65 and older to adults aged 18 and older, starting in 2026. And while there are known clinical and population health benefits to addressing malnutrition, there are few studies that link these benefits to lowering the total cost of care. Even among studies that do explore cost implications, few identify the specific nutrition care mechanisms responsible for generating savings. This gap in the evidence provides an opportunity for hospitals active in nutrition-focused quality improvement to share their findings, building the evidence base for nutrition’s inclusion in value-based payment models and incentive programs in the future. 

Conclusion 

The GMCS represents a milestone in hospital quality measurement, but it is only the beginning. By linking nutrition to broader quality measures and embedding it into standard care practices, hospitals and health systems can drive better clinical outcomes for all patients.