The Global Malnutrition Composite Score quality measure is now available for 2024 hospital reporting.
Gaining your leadership’s buy-in, and providing your team with relevant educational resources, is key to a multi-disciplinary approach to implementing a nutrition care initiative. Use the practical examples below from a variety of hospitals to understand the importance of nutrition with evidence-based summaries demonstrating the impact of malnutrition in the acute care setting.
A 2016 Healthcare Cost and Utilization Project (HCUP) analysis of U.S. hospital discharges reported that average hospital costs for all non-neonatal and non-maternal hospitals stays were $12,500, while patients diagnosed with malnutrition had hospital costs averaging up to $25,500 depending on the type of malnutrition indicated. Further, readmissions associated with malnutrition have an average cost per readmission of $16,900 per patient for those with protein-calorie malnutrition and $17,900 per patient for those with post-surgery non-absorption. This is 26% and 34% higher respectively than readmission costs for patients without malnutrition. Link to details: MQii toolkit.
Tampa General Hospital (private, not-for-profit, 1010-bed teaching hospital) implemented a multipronged series of interventions using elements of the national Malnutrition Quality Improvement Initiative (MQii) Toolkit as a mechanism to measure and improve quality, the hospital documented a 25% (2-day) overall reduction in length of stay (LOS) for malnourished/at-risk patients (from 8 days to 6 days, p<0.01) and a 22.2% (2-day) reduction in LOS for malnourished/at-risk patients with infections (from 9 days to 7 days, p=0.10). Infection rates among malnourished patients declined 35.7% (from 14% to 9%, p<0.01). Changes in readmission rates over time were not statistically significant. Link to details: Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital.
At UnityPoint Health-Des Moines, a three hospital system in Iowa, , malnutrition became an area of focus for other hospital departments. Before implementing an improved malnutrition care workflow with the implementation of the Global Malnutrition Composite Score (GMCS)—a nutrition care quality measure available for voluntary eCQM reporting starting in calendar year (CY) 2024 of the Hospital Inpatient Quality Reporting (IQR) Program—the institution estimated malnutrition was diagnosed in less than 10% of inpatients. Following a 4-month implementation pilot, malnutrition was identified in 42% of patients in the two inpatient units, resulting in what was viewed as a favorable impact on allowable length of stay and related reimbursement. Link to details: Interprofessional implementation of the Global Malnutrition Composite Score quality measure.
Recognizing that malnutrition in hospitalized patients can adversely affect health outcomes and increase the cost of care, a QI study was conducted to measure the impact of a nutrition-focused program on the malnutrition care processes of participating hospitals. The hospitals implemented the 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.
Results showed that 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. Link to details: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984333/pdf/JPEN-45-366.pdf.
To overcome rural health challenges in implementing a malnutrition care processes the paper provides 4 main insights on taking a collaborative approach, gaining administrative buy-in, education, and tackling care transitions. Link to details: The Opportunity for Quality Malnutrition Care to Improve Rural Health Outcomes and Health Equity for Older Americans, and corresponding ASA Generations blog.
Vanderbilt University Medical Center a 1000-bed urban hospital, conducted a pilot study assessing a 3-month intervention. This intervention included tailored training and education modules for different types of practitioners (physicians, registered nurses, and registered dietitian nutritionists), which were integrated into existing teaching and clinical workflows. The study observed statistically significant outcomes, including a reduction in length of stay for malnourished patients, decreased time from positive malnutrition screening to nutrition interventions, and an increased rate of physician documentation of medical diagnoses of malnutrition, among other key indicators. Link to details: Effectiveness of the Malnutrition Quality Improvement Initiative on Practitioner Malnutrition Knowledge and Screening, Diagnosis, and Timeliness of Malnutrition-Related Care Provided to Older Adults Admitted to a Tertiary Care Facility: A Pilot Study.
Spectrum Health in Grand Rapids, MI (medium-large hospital system) used Malnutrition Awareness week to distribute educational flyers and organize one-on-one educational campaigns between RDNs and clinicians. Documented 331 one-to-one malnutrition conversations with 68 physicians and 168 nurses during the week and that increased health team awareness of the role of . Link to details: Clinical Leadership and Innovation Help Achieve Malnutrition Quality Improvement Initiative Success.
Northwestern Medicine Hospital in McHenry, Illinois addressed low malnutrition screening, assessment and diagnosis documentation rates with education and resources. Nursing education emphasized the significance of thorough documentation and included protocols for triggering a dietitian consult upon identifying patients at risk of malnutrition. Physicians were educated on effective documentation practices using EHR templates, complemented by informational flyers placed strategically throughout the hospital. Link to details: Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital.
Intermountain Healthcare in Utah (a five hospital system) collaborated with their IT department to improve the documentation rate of malnutrition diagnoses. They engaged IT programmers to analyze clinical data within the health system regarding malnutrition documentation. The programmers identified a crucial challenge: ensuring that malnutrition diagnoses established by RDNs were properly integrated into patients’ health records by physicians (“moving” the malnutrition diagnosis established by RDNs into the problem list of a patient’s health record). Several strategies were implemented to address this issue. These included flagging malnutrition diagnoses within the Electronic Health Record (EHR) system to prompt physician action, conducting peer chart audits to ensure accuracy in malnutrition criteria for diagnoses, and incorporating malnutrition standards and diagnosis practices into the onboarding training for new medical staff. Link to details: Malnutrition Quality Improvement Initiative Data Support Continued Opportunities in Malnutrition Care.
Similarly, UnityPoint Health-Des Moines successfully increased documentation of malnutrition diagnoses after implementing an educational program targeted toward physicians and midlevel providers, including instructions from IT staff on how to record a malnutrition diagnosis in the malnutrition template of the EHR, followed by e-mailed evaluations and feedback on clinicians’ performance. Link to details: Malnutrition Quality Improvement Initiative Data Support Continued Opportunities in Malnutrition Care.
Tampa General Hospital used hospital-wide goals of reducing patient length of stay (LOS), infection rates, and readmission rates to focus on malnutrition. To improve nutrition care related to discharge planning, the project team created an automated Best Practice Alert (BPA) system to flag malnourished patients for the discharge planning team which triggered a consult for Social Work and allowed malnutrition to be placed on patients’ problem list. Link to details: Impact of an interdisciplinary malnutrition quality improvement project at a large metropolitan hospital.
The Legacy Salmon Creek (LSC) Medical Center (220-bed hospital in Vancouver, WA) implemented a pilot post-discharge nutrition program. Although the number of patients enrolled in the pilot program was too small to conduct statistical analyses of findings, the 30-day readmission rate among pilot program enrollees was 10%, compared with an overall average hospital 30-day readmission rate of 16.3% (as documented before the pilot program). Link to details: Extending the Reach of Hospital-Based Nutrition: A Registered Dietitian Nutritionist’s Perspective on the Malnutrition Quality Improvement Initiative and Improving Patient Recovery.
These materials were developed by the Malnutrition Quality Improvement Initiative (MQii),
a project of the Academy of Nutrition and Dietetics, Avalere, and other stakeholders who
provided guidance and expertise through a collaborative partnership. Support provided by Abbott.
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