The Problem: High Prevalence of Malnutrition in Hospitalized Patients
- Barrett M.L.
- Bailey M.K.
- Owens P.L.
- Fingar K.R.
- Hudson L.
- Chittams J.
- Griffith C.
- Compher C.
- Silver H.J.
- Pratt K.J.
- Bruno M.
- Lynch J.
- Mitchell K.
- McCauley S.M.
Seeking a Solution: Implementing Malnutrition-Focused QI
- McCullough C.M.
- Wang J.J.
- Parsons A.S.
- Shih S.C.
What Is MQii?
The Nutrition Care Process and Workflow Elements: What Are Clinical Quality Measures and eCQMs?
Health information privacy: HITECH act enforcement interim final rule.
Centers for Medicare and Medicaid Services. CMS quality strategy-meaningful measures framework.
|eCQM||CMS MUC number||Measure description||Measure objective|
|#1||MUC16-294||Completion of a malnutrition screening within 24 h of admission||Patients aged≥18 received a malnutrition screening and results are documented in their medical record within 24 h of their admission to the hospital.|
|#2||MUC16-296||Completion of a nutrition assessment for patients identified as at risk for malnutrition within 24 h of a malnutrition screening||Patients aged≥65 who were identified to be at risk of malnutrition from a screening were provided a nutrition assessment within 24 h of the screening.|
|#3||MUC16-372||Nutrition care plan for patients identified as malnourished after a completed nutrition assessment||Patients aged≥65 who were assessed and found to be malnourished should also have a documented nutrition care plan in their medical record.|
|#4||MUC16-344||Appropriate physician vs dietitian documentation of a malnutrition diagnosis||Patients aged≥65 who were assessed and found to be malnourished should have a physician-confirmed diagnosis of malnutrition documented in their medical record to ensure care plan implementation and transfer of necessary medical information upon discharge.|
Real-World Testing of the Malnutrition eCQMs
- McCullough C.M.
- Wang J.J.
- Parsons A.S.
- Shih S.C.
Measure evaluation criteria and guidance for evaluating measures for endorsement.
Centers for Medicare and Medicaid Services. CMS Measures Management System Blueprint v14.1.
Piloting the Malnutrition eCQMs: Feasibility, Reliability, and Validity
|Data element name||% Agreement||Kappa statistic of reliability (95% CI)|
|Data elements with structured data for EHR extraction|
|Completion of a malnutrition screening within 24 h of admission (eCQM #1)|
|Completion of a malnutrition screening||100||1.0|
|Malnutrition screening within 24 h of admission||97||0.87 (0.81-0.93)|
|Malnutrition screening score||95||0.88 (0.84-0.92)|
|Completion of a nutrition assessment for patients identified as at risk for malnutrition within 24 h of a malnutrition screening (eCQM #2)|
|Nutrition assessment within 24 h of screening||92||0.46 (0.35-0.57)|
|Appropriate documentation of a malnutrition diagnosis (eCQM #4)|
|Documentation of malnutrition diagnosis||89||0.28 (0.16-0.40)|
|Data element name||% Agreement between chart abstractors|
|Kappa statistic of reliability (95% CI)|
|Data elements with only chart abstraction available|
|Nutrition care plan for patients identified as malnourished after a completed nutrition assessment (eCQM #3)|
|Nutrition care plan documented||83||0.58 (0.52-0.64)|
|Nutrition assessment findings||91||0.68 (0.61-0.75)|
|Measure title (eCQM #)||Measure denominator||Measure numerator||Performance rate (%)|
|1: Completion of a malnutrition screening within 24 h of admission||2,756||1,949||70.7|
|2: Completion of a nutrition assessment for patients identified as at risk for malnutrition within 24 h of a malnutrition screening||346||98||28.3|
|3: Nutrition care plan for patients identified as malnourished after a completed nutrition assessment|
|4: Appropriate physician documentation of a malnutrition diagnosis|
Measure calculation is based off a chart abstracted sample and not representative of the entire hospital’s performance, but of the 200 records that were reviewed for abstraction; the data required for full electronic report were not available in the format necessary to report a hospital-wide performance rate.
Malnutrition Screening (eCQM#1)
Nutritional Assessment (eCQM#2)
Nutrition Care Plan (eCQM#3)
Malnutrition Diagnosis (eCQM#4)
- Barrett M.L.
- Bailey M.K.
- Owens P.L.
- Barrett M.L.
- Bailey M.K.
- Owens P.L.
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STATEMENT OF POTENTIAL CONFLICT OF INTEREST The Malnutrition Quality Improvement Initiative (MQii) is a project of the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders who participated in and provided guidance and expertise in this collaborative partnership. K. G. Nepple and C. M. Tobert are employees of the University of Iowa Hospitals and Clinics. A. F. Valladares and K. Mitchell are employees of Avalere Health. M. M. Yadrick is an employee of Computrition, Inc.
FUNDING/SUPPORT Publication of this supplement was supported by Abbott. The Academy of Nutrition and Dietetics does not receive funding for the MQii. Avalere Health's work to support the MQii was funded by Abbott. The University of Iowa received financial support from Avalere Health.