Research Original Research: Brief| Volume 118, ISSUE 1, P101-109, January 2018

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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

Published:December 20, 2017DOI:



      Malnutrition is present in 30% to 50% of hospitalized patients aged 60 years or older. As few as 3.2% of patients identified as high risk have a malnutrition diagnosis documented by medical providers. The Malnutrition Quality Improvement Initiative (MQii) aims to reduce the burden of hospital malnutrition by improving the process and delivery of care.


      To evaluate implementing the MQii toolkit of best practice resources for screening, diagnosis, documentation, and timeliness of malnutrition care.


      This 6-month prospective pilot included a 3-month intervention with training and education modules tailored to type of practitioner and integrated into existing teaching and clinical workflow.


      Forty-five health care professionals from geriatric, general medicine, and general surgery units at Vanderbilt University Hospital during January to June 2016.

      Main outcome measures

      Malnutrition knowledge by 30-item questionnaire; electronic medical record (EMR) documentation; and timeliness of malnutrition screening, diagnosis, intervention, and discharge planning.

      Statistical analyses

      Analysis of variance was used to test change over time.


      Malnutrition knowledge score increased 14%, from 39% to 53% (P=0.009). All patients whose nutrition screen indicated they were malnourished/high risk had registered dietitian nutritionist diagnosis of malnutrition documented in the EMR. The proportion who had medical provider (physician, nurse practitioner, or physician assistant) malnutrition diagnosis documented in the EMR increased 11.6%, from 26.7% to 38.3% (P=0.08). About 95% of malnourished/high risk patients had a documented intervention addressing malnutrition. Inclusion of malnutrition care in the discharge plan increased 4.8%, from 70.0% to 74.8% (P=0.13).


      This pilot study demonstrated feasibility of implementing the MQii resources to improve malnutrition knowledge and professionals’ skills relevant to screening, diagnosis, intervention, and timeliness of malnutrition care. By optimizing the process and delivery of malnutrition care, it is expected that the quality of clinical care provided to older adults with malnutrition or at high malnutrition risk will improve.


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      H. J. Silver is a research associate professor and director, Vanderbilt Diet, Body Composition, and Human Metabolism Core, Vanderbilt University Medical Center, Nashville, TN, and a health scientist, Tennessee Valley Healthcare System, Nashville.


      K. J. Pratt is a director, Avalere Health, Washington, DC.


      M. Bruno is a director, Avalere Health, Washington, DC.


      J. Lynch is a director, Avalere Health, Washington, DC.


      K. Mitchell is a senior vice president, Avalere Health, Washington, DC.


      S. M. McCauley is a senior director, quality management, Academy of Nutrition and Dietetics, Chicago, IL.

      Linked Article

      • Malnutrition Intervention Implementation
        Journal of the Academy of Nutrition and DieteticsVol. 118Issue 5
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          We read with great interest the article by Silver and colleagues entitled “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.”1 We would like to commend the authors for their work in evaluating the implementation of the Malnutrition Quality Improvement Initiative (MQii) toolkit on patients’ screening, diagnosis, documentation, and timeliness of malnutrition care.
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