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Evaluation of the Validity and Feasibility of the GLIM Criteria Compared with PG-SGA to Diagnose Malnutrition in Relation to One-Year Mortality in Hospitalized Patients
The Global Leadership Initiative on Malnutrition (GLIM) approach to diagnose malnutrition was published in 2018. An important next step is to use the GLIM criteria in clinical investigations to assess their validity and feasibility.Monitoring Rates of Malnutrition Risk in Outpatient Cancer Centers Utilizing the Malnutrition Screening Tool Embedded into the Electronic Health Record
The risk of malnutrition in patients with cancer is well documented. However, screening to identify patients at risk in ambulatory cancer centers is not standardized nor uniform. The 2-question Malnutrition Screening Tool (MST) is validated in the ambulatory oncology setting and endorsed by the Academy of Nutrition and Dietetics.Adult Malnutrition (Undernutrition) Screening: An Evidence Analysis Center Systematic Review
Malnutrition screening relies on quick and easy-to-use tools that require minimal training of users. Valid and reliable tools should avoid under-referral of adults with a malnutrition diagnosis or over-referral of those without a malnutrition diagnosis to dietitians.Development and Pilot Testing of the Prioritizing Food Security Solutions Toolkit
Food security is defined as “all people, at all times, hav[ing] physical and economic access to sufficient safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life.”1 In the United States, about 15 million households are food insecure, meaning that they had inadequate money or other resources to obtain enough food to meet the needs of the household members.2 Food insecurity affects families all over the world, with an estimated 605 million children under the age of 15 living with an adult who reports being moderately or severely food insecure.The Malnutrition Quality Improvement Initiative: A Multiyear Partnership Transforms Care
The Academy of Nutrition and Dietetics, representing credentialed nutrition and dietetics practitioners—registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered, and students and interns and professionals holding nutrition and dietetics undergraduate and advanced degrees—and Avalere Health, a Washington, DC–based strategic advisory services firm, have led the charge in closing malnutrition gaps with the Malnutrition Quality Improvement Initiative (MQii), a national nutrition-focused quality improvement initiative.Hospital Nutrition Care Betters Patient Clinical Outcomes and Reduces Costs: The Malnutrition Quality Improvement Initiative Story
Disease-associated malnutrition and malnutrition-associated diseases and conditions are common among hospitalized patients, yet all too often such malnutrition goes unrecognized and untreated. As a result, patient quality outcomes worsen, excess costs of care are incurred, and patients and their families are disappointed and alarmed by slow, stalled, or no recovery from illness or injury. Now more than ever is the time for key health care stakeholders—from providers to patients—to recognize and harness the potential of nutritional care to help prevent and treat malnutrition and to advance value-based medicine in the current health care reimbursement environment.Academy of Nutrition and Dietetics: Revised 2019 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Clinical Nutrition Management
Clinical nutrition management (CNM) encompasses the varied roles of registered dietitian nutritionists (RDNs) with administrative responsibilities for clinical nutrition services within an organization. Although RDNs in CNM are typically employed in acute care, they are also employed in settings where management of nutrition services is required, such as foodservice departments, ambulatory clinics, telehealth services, public health organizations, post-acute and long-term care, rehabilitation, and correctional facilities, or specialty departments, for example, dialysis units or cancer centers.Identifying and Managing Malnourished Hospitalized Patients Utilizing the Malnutrition Quality Improvement Initiative: The UPMC Experience
Registered dietitian nutritionists at University of Pittsburgh Medical Center, a group of 40 academic, community, and specialty hospitals in Pittsburgh, PA, recognized the need to improve the identification and management of malnourished adult patients at their institutions. It was decided to pilot the Malnutrition Quality Improvement Initiative (MQii) at two institutions within their health care system. The MQii is based on the dual-pronged approach of malnutrition-focused electronic clinical quality measures and a quality improvement toolkit (MQii Toolkit), to help identify and manage malnourished adult patients.Clinical Leadership and Innovation Help Achieve Malnutrition Quality Improvement Initiative Success
Malnutrition is a frequent, but often overlooked clinical issue that can significantly impact patient health outcomes and thus has been identified as a critical target for quality improvement. One recent advancement helping build momentum in quality improvement is the Malnutrition Quality Improvement Initiative (MQii). Frameworks like the MQii need clinical leadership to achieve success. A new taxonomy for clinical dietetics leadership describes five components of leadership behaviors—change, patient focus, self-direct, technical, and relationship—that align with the MQii tools and resources.Extending the Reach of Hospital-Based Nutrition: A Registered Dietitian Nutritionist's Perspective on the Malnutrition Quality Improvement Initiative and Improving Patient Recovery
Registered dietitian nutritionists (RDNs) at Legacy Salmon Creek Medical Center (Washington) recognized a need to use nutrition to help patients recover faster and stay independent longer. With the goal of decreasing 30-day hospital readmission rates, the RDNs at Legacy Salmon Creek developed a program for posthospital nutrition care. The intervention was a pilot program designed to provide palatable and nutritious meals to patients at home during a 4-week, postdischarge interval. The RDNs obtained approval from hospital administrators and received buy-in from nursing staff who participated in RDN-led training on malnutrition awareness and risk screening.Enhancing Identification and Management of Hospitalized Patients Who Are Malnourished: A Pilot Evaluation of Electronic Quality Improvement Measures
Malnutrition in hospitalized patients has long been recognized as a contributor to poor patient outcomes; malnutrition often leads to higher costs of care. Thus, it is important to improve the identification of patients who are at risk for malnutrition or already malnourished and to initiate treatment to optimize outcomes. The Malnutrition Quality Improvement Initiative (MQii) is based on a dual-pronged approach consisting of a set of four electronic clinical quality measures and a Quality Improvement Toolkit that support delivery of high-quality malnutrition care by clinicians including nurses, registered dietitian nutritionists, and physicians.Improving Malnutrition in Hospitalized Older Adults: The Development, Optimization, and Use of a Supportive Toolkit
Malnutrition is a leading cause of morbidity and mortality, especially among older adults. However, diagnosis and treatment of malnutrition in the hospital setting are often overlooked. In recent years, quality improvement (QI) initiatives to increase the assessment and treatment of malnutrition in hospital settings have been implemented and shown to improve both patient health and economic outcomes. The Malnutrition Quality Improvement Initiative (MQii) Toolkit was designed in an effort to support hospitals seeking to implement malnutrition QI initiatives.Quality Improvement as the Foundation for Health Care Advancement
The rising cost of health care continues to be a key driver of the growing national debt. Improving the nation’s health requires a dedicated and holistic advancement of access to quality and affordable patient-centered health care, as well as a strong focus on the core elements of prevention, including nutrition. Programs must be put in place, such as the Malnutrition Quality Improvement Initiative (MQii), to identify and address the root causes of malnutrition. Registered dietitian nutritionists have an important role to lead malnutrition quality improvement efforts in their organizations to promote better patient health outcomes, keep health care costs affordable, and protect Medicare.Academy of Nutrition and Dietetics: Quality Measures for Malnutrition
Malnutrition has long been an underdiagnosed and undertreated condition among older adults. The Academy of Nutrition and Dietetics (Academy) as measure steward worked with Avalere Health to develop four electronic clinical quality measures (eCQMs) for malnutrition. In a collaborative partnership with other stakeholders who provided guidance and expertise, measures concepts were established. The measures discussion allowed for greater understanding of how nutrition care processes and executed plans currently occur.Call for Action for Malnutrition Policy
The Older Americans Act is anticipated to be reauthorized in the 116th Congress. The law provides critical services, including congregate and home-delivered nutrition services to older adults who might otherwise be at risk of malnutrition. The prevention of malnutrition, a growing concern particularly in older adult populations, would save taxpayer dollars and more importantly, improve health care quality. Identifying and treating malnutrition is more than increasing access to food or addressing food insecurity that warrants the attention of health care providers and our nation’s policymakers.Protein Energy Malnutrition Is Associated with Worse Outcomes in Sepsis—A Nationwide Analysis
Protein-energy malnutrition (PEM), resulting from depleted energy and nutrient stores, compromises the body’s defense systems and may exacerbate sepsis and its impact. However, population-based studies examining the association of PEM on the prevalence and health-care burden of sepsis are lacking.The Association between Oral Nutritional Supplements and 30-Day Hospital Readmissions of Malnourished Patients at a US Academic Medical Center
Malnutrition affects up to 50% of hospitalized patients and contributes to adverse health and economic outcomes, but often remains unrecognized or undertreated.Differences in Respiratory Muscle Strength Measures in Well-Nourished and Malnourished Hospitalized Patients
Objective indicators of nutritional status are essential for accurate identification of malnutrition. Previous research has indicated an association between measures of respiratory muscle strength (RMS) and nutritional status. Measurement of RMS—including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP)—may provide evidence to support the assessment of nutritional status in hospitalized patients.Nutrition Care Process (NCP) Update Part 2: Developing and Using the NCP Terminology to Demonstrate Efficacy of Nutrition Care and Related Outcomes
Nutrition and dietetics practitioners around the world use the Nutrition Care Process Terminology (NCPT) to communicate the Nutrition Care Process (NCP).1 In this article, nutrition and dietetics practitioners or professionals; dietitians; dietitians-nutritionists; and dietetic technicians, registered, are collectively referred to as professionals. The NCPT is a standardized terminology or controlled vocabulary that complements the NCP, a systematic problem-solving roadmap for planning and providing nutrition and dietetic care to individuals and populations, and researching related outcomes.Patterns in Adult Malnutrition Assessment and Diagnosis by Registered Dietitian Nutritionists: 2014-2017
Malnutrition in hospitalized patients is associated with increased morbidity and mortality.1 It is estimated that up to one-third of patients admitted to a hospital are malnourished and that the majority of those patients’ nutritional status will decline during admission without appropriate nutrition care.2-4 The latest Healthcare Cost and Utilization Project data show that 7.1% of hospitalized patients received a diagnosis of malnutrition,5 which is an increase from the previous rate (3.2%)6 but still significantly lower than the estimated prevalence, illustrating the need for better identification of malnutrition.Implementation of an Automated Pediatric Malnutrition Screen Using Anthropometric Measurements in the Electronic Health Record
Nutrition evaluation and intervention in hospitalized pediatric patients is critical, because undernutrition negatively impacts physical and cognitive development, wound healing, immune function, mortality, and quality of life.1-4 Multiple, validated pediatric nutrition screening tools are available, yet no consensus on the ideal tool exists.5-9 Generally, the aims of the nutrition screening process are identification of current nutrition status and determination of a need for further nutrition assessment and intervention.Elevating Malnutrition Care Coordination for Successful Patient Transitions
In 2013, the Academy of Nutrition and Dietetics entered into a joint project with Avalere Health to improve quality of care in the United States health care systems by recognizing the unaddressed areas of malnutrition. Avalere Health, an Inovalon Company, is a strategic advisory company whose core purpose is to create innovative solutions to complex health care problems. Together the Academy and Avalere Health embarked on a collaborative journey to advance high-quality, patient-centered care for those malnourished or at risk for malnutrition.Poor Nutritional Status among Low-Income Older Adults: Examining the Interconnection between Self-Care Capacity, Food Insecurity, and Depression
Understanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs.Early Implementation of Malnutrition Clinical Quality Metrics to Identify Institutional Performance Improvement Needs
The Centers for Medicare and Medicaid Services (CMS) is part of the federal government and the largest health care payer in the United States.1 The CMS writes regulations to ensure they only pay for high-quality, safe health care. To better measure quality in the U.S. health care system, the CMS developed electronic clinical quality measures (eCQMs), which became available for voluntary use in 2013.2 Effective calendar year (CY) 2016, hospitals are required to electronically report clinical quality measures (CQMs) as a part of hospital inpatient quality reporting (IQR) and the electronic health record (EHR) incentive programs (more commonly known as “meaningful use” of the EHR).Identifying and Documenting Malnutrition in Inpatient Rehabilitation Facilities
Recently there has been strong focus on appropriate nutrition screening, assessment, intervention, and documentation in multiple care settings and across the transition of care.1 Several articles have guided clinicians to understand the impact of malnutrition diagnosis, intervention, and coding on hospital payment, case mix index, risk of mortality, and severity of illness.2-6 Limited studies explain the impact (or lack thereof) of malnutrition diagnosis and coding in inpatient rehabilitation facilities (IRFs); however, with a reported prevalence of malnutrition in patients receiving rehabilitative services between 38% and 51%, more attention needs to be given to this population.
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