The MQii Learning Collaborative is a community of clinicians committed to improving delivery of malnutrition care in hospitals and health systems across the US. The MQii Learning Collaborative was established in 2016 through a partnership between the Academy and Avalere.
Learning Collaborative Efforts
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.
The Academy and Avalere work 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.
In 2022, the Global Malnutrition Composite Score was approved by CMS for inclusion in the Hospital IQR Program. The MQii team now creates and disseminates resources to support hospitals and healthcare stakeholders in understanding the value of the GMCS, and reporting performance on the measure as appropriate.
Learning Collaborative Participation
Learning Collaborative participants in the past contributed to the development and testing of individual malnutrition quality measures to track and monitor improvement from malnutrition quality improvement projects. These partnerships led to the development and testing of theGlobal Malnutrition Composite Score. The MQii appreciates the collaboration of clinical nutrition managers and their hospitals towards this milestone. In 2023 and beyond, the MQii is broadening access to Learning Collaborative resources to additional healthcare stakeholders, while still retaining the Learning Collaborative’s purpose for advancing malnutrition care quality.
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As of the end of 2022, 327 hospital sites participated across 38 states and Puerto Rico. The MQii team looks forward to expanding access to MQii Learning Collaborative resources to other stakeholders, and thanks our original hospital partners for their collaboration.
States with a Learning Collaborative Participant as of 2022
Insights from Clinicians Undertaking an MQii Project
“Anybody can do this whether this is your first journey into quality or not. The MQii provides the framework to walk you through the process and teach the necessary and important steps. I wish I had MQii years ago to help me get to where we are now.” -MQii Learning Collaborative Participant
Value of the MQii / Why the MQii
We have come so far on this journey and I believe awareness of the prevalence of malnutrition within our organization has grown tremendously. I believe that through our ground work and our work on the MQii, we now have a greater understanding as an organization of the impact that malnutrition has on the health and wellness of our patients, their ability to heal, etc.
My involvement on the MQii team allowed me to step back from my day-to-day duties and look at how a low-cost intervention can have an immediate and long term impact on our patients. It also revealed the complexities of making changes within a hospital system.
The MQii definitely opened the door to resources needed to help collect data as well as put improvement plans in place whether it be with IT, nursing, medical staff, etc. Our staff is highly respected for their clinical skills as well as their ability to lead facility and system level projects/QI. Right now nutrition is a focus across the organization. I call it the “Years of Nutrition”.
Anybody can do this whether this is your first journey into quality or not. The MQii provides the framework to walk you through the process and teach the necessary and important steps. I wish I had MQii years ago to help me get to where we are now.
Registered Dietitian Nutritionist (RDN) Insights
I would say that it’s just the right thing to do, for your staff, your organization and most importantly your patients and community. I think many times as dietitians we feel that nutrition isn’t as important to others as it is to us, and that simply is not true. I have been so humbled by the commitment of my project team.
I was burned out, and felt like I might even need to consider a career change and participating in the MQii has given my work such greater meaning. I feel like I am doing something important, something that matters to all patients, and making a difference has been so satisfying. I have loved the new challenge and the new lessons. I’ve grown a lot, and I am so happy to be on this journey.
My work on the MQii has given me the platform to talk about malnutrition and highlight the role and skill set of my Registered Dietitians within my organization. RDNs are such a valuable part of the interdisciplinary team and my desire is for them to work at the top of their license and be recognized for doing so.
Biggest Opportunities Identified
Our biggest opportunity is to correctly identify malnutrition and work together to treat it. By working with members throughout the care team, we are becoming more aware of gaps in communication and are working towards our goal of identifying malnourished patients.
The first few team meetings were very enlightening. We worked through the MQii mapping process and we were able to immediately identify that screening patients within the first 24 hours of admission was the area we needed to focus our attention.
I believe our biggest opportunity will be in the discharge and post-discharge process. We were unaware of the gap that existed at discharge as far as nutrition and ONS instructions, but found that many times the patient leaves the hospital and the RDN is not aware of the discharge.
Interdisciplinary Team Insights
I have been so surprised by the fact that our clinicians were happy to join my project team when they realized the importance to our patients. They are very willing to be a part of this journey and are enjoying this as much as I am.
Everyone had the philosophy that the MQii was best for the patient, and was interested in being involved in a project that affected a large percentage of our population. Each discipline brought a unique perspective to the table.
Physician and IT Insights
As a physician, I believe Registered Dietitians with their knowledge and expertise are the tip of the spear, and an integral part of our effort to treat our malnourished patients.
It allowed me to be introspective and ask myself, “What could I do outside of identifying and treating “malnutrition” to improve the care of the patient? It also prompted me to improve my use of the “Problem List” in my documentation. Furthermore, my appreciation of the hard work of other healthcare professionals and their perspective when addressing the unique issues of patient care was enhanced.
Culture of Quality
Quality Improvement is a top priority within our organization, so as soon as I introduced the MQii and the possibility of CMS adopting malnutrition as one of their eCQMs, she was immediately on board and supportive. We like the idea of pioneering and innovating and being a national leader in advancing malnutrition quality improvement.
Involvement in MQii is helping us further advance an already strong culture of quality by providing a structured framework for identification of gaps and a strategy to achieve our aims.
Achievements and Lessons Learned
Do it now, don’t wait. It doesn’t have to be a big hospital-wide project. Start small to learn the process. Maybe pick a small project on one nursing unit, or a small subset of patients. Small tests of change can turn into larger impacts down the road.
Hospital leadership understanding and trusting your needs can have the biggest impact for opening the doors needed to make progress. It is vital to engage them from the start.
Yes, I encourage everyone to take the next right step and begin a Malnutrition Quality Improvement Initiative in your organization. Share the data, use the resources available in the MQii toolkit, gain support from key individuals in your organization and build a team of individuals that are high performers committed to worthwhile work and making a difference. You will not regret going on this journey. It has made my role as a CNM more meaningful and it has given me the opportunity to highlight my staff as the nutrition experts that they are, as well as providing quality care and improved outcomes for our patients.
Resources to support you and your colleagues in caring for patients experiencing or at risk for malnutrition throughout the COVID-19 pandemic. Learn more.
These materials were developed by the Malnutrition Quality Improvement Initiative (MQii),
a project of the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders who
provided guidance and expertise through a collaborative partnership. Support provided by Abbott.