Advertisement

Comprehensive Application of the Malnutrition Quality Improvement Initiative (MQII) Toolkit to Pediatric Malnutrition Care

Published:November 10, 2020DOI:https://doi.org/10.1016/j.jand.2020.08.091
      As pediatric registered dietitian nutritionists (RDNs) make addressing malnutrition a critical part of their nutrition care process (NCP) and integrate malnutrition quality improvement into their health care facilities, they have looked to the Pediatric Nutrition Practice Group (PNPG) for guidance on how to best achieve this goal in the care of infants, children, and adolescents. The Malnutrition Quality Improvement Initiative (MQii) was developed by the Academy of Nutrition and Dietetics (Academy), Avalere Health, and other stakeholders to provide guidance for malnutrition quality improvement efforts through key technical expert and advisory roles.
      • McCauley S.M.
      • Barrocas A.
      • Malone A.
      Hospital nutrition care betters patient clinical outcomes and reduces costs: The malnutrition quality improvement initiative story.
      MQii is a dual-pronged approach to support quality improvement (QI) for malnutrition care based on a set of four malnutrition-focused electronic clinical quality metrics (eCQMs) and a malnutrition QI toolkit with resources to guide implementation of QI activities.
      • McCauley S.M.
      • Barrocas A.
      • Malone A.
      Hospital nutrition care betters patient clinical outcomes and reduces costs: The malnutrition quality improvement initiative story.
      The MQii Toolkit
      Malnutrition Quality Improvement Initiative
      2nd ed. Malnutrition Quality Improvement Initiative website. 2018.
      is a well created and comprehensive framework developed for patients aged 65 years and older. The goals of the MQii include reducing variation in clinical practice for malnutrition care across different care providers and settings; improving clinicians’ knowledge of the importance of malnutrition and best practices for optimal malnutrition care delivery; and exploring how optimal malnutrition care impacts cost of care proxies such as average length of stay and 30-day all-cause readmissions for patients who are malnourished or at risk for malnutrition.
      • McCauley S.M.
      • Barrocas A.
      • Malone A.
      Hospital nutrition care betters patient clinical outcomes and reduces costs: The malnutrition quality improvement initiative story.
      ,
      Malnutrition Quality Improvement Initiative
      2nd ed. Malnutrition Quality Improvement Initiative website. 2018.
      This publication provides guidance for pediatric nutrition practitioners to implement malnutrition QI activities and evaluate the eCQMs in pediatrics, providing age-appropriate nutrition screening, assessment, care plan, and documentation resources where needed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • McCauley S.M.
        • Barrocas A.
        • Malone A.
        Hospital nutrition care betters patient clinical outcomes and reduces costs: The malnutrition quality improvement initiative story.
        J Acad Nutr Diet. 2019; 119: S11-S14
        • Malnutrition Quality Improvement Initiative
        2nd ed. Malnutrition Quality Improvement Initiative website. 2018.
        • Barrett M.L.
        • Bailey M.K.
        • Owens P.L.
        Non-maternal and non-neonatal inpatient stays in the United States involving malnutrition, 2016. U.S. Agency for Healthcare Research and Quality. 2018.
        www.hcup-us.ahrq.gov/reports.jsp
        Date accessed: February 13, 2020
        • Tolbert C.M.
        • Mott S.L.
        • Nepple K.G.
        Malnutrition diagnosis during adult inpatient hospitalizations: Analysis of a multiinstitutional collaborative database of academic medical centers.
        J Acad Nutr Diet. 2018; 118: 125-131
        • White J.
        • Guenter P.
        • Jenson G.
        • et al.
        Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (Undernutrition).
        J Acad Nutr Diet. 2012; 112: 730-738
        • Becker P.
        • Carney L.N.
        • Corkins M.R.
        • et al.
        Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition).
        J Acad Nutr Diet. 2014; 114: 1988-2000
        • Goldberg D.L.
        • Becker P.J.
        • Brigham K.
        • et al.
        Identifying malnutrition in preterm and neonatal populations: Recommended indicators.
        JAND. 2018; 118: 1571-1582
        • Medico T.
        Characterizing and communicating malnutrition of hospitalized pediatric patients: A nuanced challenge for nutrition professionals.
        Support Line. 2017; 39: 17-23
      1. Weiss AJ, Fingar KR, Barrett ML, et al. Characteristics of hospital stays involving malnutrition, 2013. HCUP Statistical Brief #210. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb–. PMID: 27854406.

        • Corkins M.R.
        • Guenter P.
        • DiMaria-Ghalili R.A.
        • et al.
        Malnutrition diagnoses in hospitalized patients: United States, 2010.
        JPEN. 2014; 38: 186-195
        • Carvalho-Salemi J.
        • Salemi J.
        • Wong-Vega M.
        • et al.
        Malnutrition among hospitalized children in the United States: Changing prevalence, clinical correlates, and practice patterns between 2002 and 2011.
        J Acad Nutr Diet. 2018; 118: 40-51
        • Ladd M.R.
        • Garcia A.V.
        • Leeds I.L.
        • et al.
        Malnutrition increase the risk of 30-day complications after surgery in pediatric patients with Crohn disease.
        J Pediatr Surg. 2018; 53: 2336-2345
        • Ehwerhemuepha L.
        • Bendig D.
        • Steele C.
        The effect of malnutrition on the risk of unplanned 7-day readmission in pediatrics.
        Hosppeds. 2018; 8: 207-212
        • McCauley S.M.
        • Khan M.
        • D’Andrea C.
        Academy of Nutrition and Dietetics: Quality measures for malnutrition.
        J Acad Nutr Diet. 2019; 119: 1541-1544
        • McCauley S.
        • Mitchell K.
        • Heap A.
        The malnutrition quality improvement initiative: a multiyear partnership transforms care.
        J Acad Nutr Diet. 2019; 119: S18-S24
        • CMS Approves Inclusion of Malnutrition Quality Measures
        Academy of Nutrition and Dietetics website. 2019.
        • Blankenship J.
        • Blancato R.B.
        • Kelly R.
        Quality improvement as the foundation for health care advancement.
        J Acad Nutr Diet. 2019; 119: S15-S17
        • Nutrition Care Process
        The Evidence Analysis Library of the Academy of Nutrition and Dietetics.
        https://www.andeal.org/ncp
        Date accessed: February 13, 2020
        • Malnutrition Clinical Characteristics Validation and Staffing Optimization Study (MCC Study)
        ClinicalTrials.gov Identifier: NCT03928548. Clinical Trials website. 2019.
        https://clinicaltrials.gov/ct2/show/NCT03928548
        Date accessed: February 13, 2020
        • Bellini S.G.
        • Becker P.J.
        • Carney L.N.
        • Corkins K.G.
        • Medico T.
        • Van Poots H.A.
        Current practices using pediatric malnutrition indicators: A survey of dietitians working in pediatrics.
        Nutr Clin Pract. 2020; 35: 1080-1086
        • Green Corkins K.
        Nutrition-focused physical examination in pediatric patients.
        Nutr Clin Pract. 2015; 30: 203-209
        • MQii Readiness Questionnaire
        • Malnutrition Quality Improvement Initiative website. 2016
        • Principles and Models of Quality Improvement
        Malnutrition Quality Improvement Initiative website. 2016.
        • MQii Team Roles and Clinical Workflow Mapping
        Malnutrition Quality Improvement Initiative website.
        • Writing Group of the Nutrition Care Process/Standardized Language Committee
        Nutrition care process and model part I: The 2008 update.
        J Am Diet Assoc. 2008; 108: 1113-1117
        • Field L.B.
        • Hand R.K.
        Differentiating malnutrition screening and assessment: A nutrition care process perspective.
        J Acad Nutr Diet. 2015; 115: 824-828
        • Evidence Analysis Library
        Nutrition Screening Pediatrics. 2018.
        https://www.andeal.org/topic.cfm?menu1/45767
        Date accessed: February 13, 2020
        • Becker P.
        • Gunnell Bellini S.
        • Wong Vega M.
        • et al.
        Validity and reliability of pediatric nutrition screening tools for hospital, outpatient, and community settings: A 2018 evidence analysis center systematic review.
        J Acad Nutr Diet. 2020; 120: 288-318
        • Secker D.J.
        • Jeejeebhoy K.N.
        Subjective Global Nutritional Assessment for children.
        Am J Clin Nutr. 2007; 85: 1083-1089
        • Phillips C.A.
        • Bailer J.
        • Foster E.
        • et al.
        Implementation of an automated pediatric malnutrition screen using anthropometric measurements in the electronic health record.
        J Acad Nutr Diet. 2019; 119: 1243-1249
        • McCarthy H.
        • Dixon M.
        • Crabtree I.
        • Eaton- Evans M.J.
        • McNulty H.
        The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP!) for use by healthcare staff.
        J Human Nutr Diet. 2012; 25: 311-318
        • Huysentruyt K.
        • Alliet P.
        • Muyshont L.
        The STRONGkids nutritional screening tool in hospitalized children: a validation study.
        Nutrition. 2013; 26: 1356-1361
        • Gerasimidis K.
        • Macleod I.
        • Maclean A.
        • et al.
        Performance of the novel Paediatric Yorkhill Malnutrition Score (PYMS) in hospital practice.
        Clin Nutr. 2011; 30: 430-435
        • White M.
        • Lawson K.
        • Ramsey R.
        • et al.
        Simple nutrition screening tool for pediatric inpatients.
        J Parenter Enteral Nutr. 2016; 40: 392-398
        • Skipper A.
        • Ferguson M.
        • Thompson K.
        • et al.
        Nutrition screening tools.
        J Parenteral Enteral Nutr. 2012; 36: 292-298
        • Vermilyea S.
        • Slicker J.
        • El-Chammas K.
        • et al.
        Subjective global nutritional assessment in critically ill children.
        J Parenter Enteral Nutr. 2013; 37: 659-666
        • Carniel M.P.
        • Santetti D.
        • Andrade J.S.
        • et al.
        Validation of a subjective global assessment questionnaire.
        Jornal de pediatria. 2015; 91: 596-602
        • Belanger V.
        • McCarthy A.
        • Marcil V.
        • et al.
        Assessment of malnutrition risk in Canadian pediatric hospitals: A multicenter prospective cohort study.
        Pediatrics. 2019; 205: 160-167
        • Mehta N.M.
        • Corkins M.R.
        • Lyman B.
        • et al.
        Defining pediatric malnutrition: A paradigm shift toward etiology-related definitions.
        J Parenter Enteral Nutr. 2013; 37: 460-481
        • Bouma S.
        Diagnosing pediatric malnutrition: Paradigm shifts of etiology-related definitions and appraisal of the indicators.
        Nutr Clin Pract. 2017; 32: 52-67
        • Abraham A.G.
        • Mak R.H.
        • Mitsnefes M.
        • et al.
        Protein energy wasting in children with chronic kidney disease.
        Pediatr Nephrol. 2014; 29: 1231-1238
        • Bouma S.
        M-Tool Michigan’s malnutrition diagnostic tool.
        Infant Child Adolesc Nutr. 2014; 6: 60-61
      2. Texas Children’s Hospital Pediatric Nutrition Reference Guide. 12th ed. Texas Children’s Hospital, Houston2019
        • Phillips W.
        Accurate documentation of malnutrition diagnosis reflects increased healthcare resource utilization.
        Nutr Clin Pract. 2015; 30: 604-608
        • Sturgeon J.
        APR-DRGs in the Medicaid population.
        For the Record. 2013; 25: 6
        • Phillips W.
        • Browning M.
        A clinician’s guide to defining, identifying, and documenting malnutrition in hospitalized patients.
        Pract Gastroenterol. 2017; 169: 26-33
        • Phillips W.
        • Doley J.
        Granting order writing privileges to RDNs can decrease costs in acute care hospitals.
        J Acad Nutr Diet. 2017; 117: 840-847
        • Therapeutic Diet Orders in Hospitals and Long Term Care Facilities
        Academy of Nutrition and Dietetics website. 2019.
        • Dialogue Proceedings/Advancing Patient-Centered Malnutrition Care Transitions
        Avalere website. 2018.
      3. Medicare and Medicaid Programs; Revisions to requirements for discharge planning for hospitals, critical access hospitals, and home health agencies, and hospital and critical access hospital changes to promote innovation, flexibility, and improvement in patient care. Federal Register. 2019. https://www.federalregister.gov/d/2019-20732. Accessed October 20, 2020.

      4. Record of Care, Treatment and Services RC.02.04.01. Comprehensive Accreditation Manual for Hospitals (CAMH): The Official Handbook. Oakbrook Terrace, IL: Joint Commission Resources; January 1, 2020.

      5. MQii Tools and Resources. Malnutrition Quality Improvement Initiative website.
        http://malnutritionquality.org/resources.html
        Date accessed: February 13, 2020
        • Data Management Guide
        Available for download at MQii Tools and Resources. Malnutrition Quality Improvement Initiative website.
        http://malnutritionquality.org/resources.html
        Date accessed: February 13, 2020
        • McCauley S.M.
        • Barrocas A.
        • Malone A.
        Malnutrition quality improvement initiative yields value for interdisciplinary patient care and clinical nutrition practice.
        J Acad Nutr Diet. 2019; 119: S1-S72

      Biography

      W. Phillips, MS, RD, CD, NWCC, FAND, is a Regional Vice President, Morrison Healthcare, St. George, UT.

      Biography

      P. J. Becker, MS, RDN, CSP, FAND, is a pediatric/neonatal nutrition specialist—RDIII, Dayton Children’s Hospital, Dayton, OH.

      Biography

      M. Wong Vega, MS, RD, is a senior pediatric clinical dietitian, Texas Children's Hospital, Houston, TX.

      Biography

      E. Smith, MA, RD, LDN, is an inpatient clinical nutrition manager, Children’s Hospital of Philadelphia, Philadelphia, PA.

      Biography

      S. Konek, MA, RDN, CSP, LD, FAND, is a partner, Pediatric Nutrition Partners, LLC, Oakwood, OH.

      Biography

      J. Bailer RD-AP, LDN, Registered Dietitian III, Children’s Hospital of Philadelphia, Philadelphia PA.

      Biography

      J. Carvalho-Salemi, MPH, RDN, LD, is a senior pediatric dietitian, Nephrology ǀ Texas Children’s Hospital, Lutz, FL.