Abstract
Background
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.
Objective
To evaluate implementing the MQii toolkit of best practice resources for screening,
diagnosis, documentation, and timeliness of malnutrition care.
Design
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.
Participants/setting
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.
Results
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).
Conclusions
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.
Keywords
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Biography
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.
Biography
K. J. Pratt is a director, Avalere Health, Washington, DC.
Biography
M. Bruno is a director, Avalere Health, Washington, DC.
Biography
J. Lynch is a director, Avalere Health, Washington, DC.
Biography
K. Mitchell is a senior vice president, Avalere Health, Washington, DC.
Biography
S. M. McCauley is a senior director, quality management, Academy of Nutrition and Dietetics, Chicago, IL.
Article info
Publication history
Published online: December 20, 2017
Accepted:
August 17,
2017
Received:
January 3,
2017
Footnotes
Supplementary materials: Figure 2 is available online at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT The study was funded in part by a grant to H. J. Silver from Avalere Health. The Malnutrition Quality Improvement Initiative (MQii) is a project of the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders who provide expertise and guidance through a collaborative partnership. Support for the MQii was provided by Abbott (Columbus, OH).
Identification
Copyright
© 2018 by the Academy of Nutrition and Dietetics.
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Access this article on ScienceDirectLinked Article
- Malnutrition Intervention ImplementationJournal of the Academy of Nutrition and DieteticsVol. 118Issue 5
- PreviewWe 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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