As public and private stakeholders demand higher quality of care in the hospital setting, hospitalists play a critical role in leading performance improvement. As hospitalists seek ways to improve quality and lower costs, malnutrition among hospitalized patients – particularly older adults – offers a prime opportunity. Evidence suggests that 20-50% of patients are at-risk for or are malnourished at hospital admission (Barker et al., 2011), but only 7% are diagnosed by medical providers (Weiss et al., 2016). In turn, malnutrition is associated with higher rates of infection, pressure ulcers, length of stay and readmissions, leading to hospital costs of $42 billion annually (Weiss et al., 2016).
To address malnutrition care gaps, Avalere and the Academy of Nutrition and Dietetics established the Malnutrition Quality Improvement Initiative (MQii), a multi-stakeholder effort to identify tools to support hospital-based care teams in improving malnutrition quality standards. Given the multidisciplinary nature of malnutrition care, hospitalists are centrally positioned to deploy these tools for quality improvement (QI) efforts.
Hospitalists are critical to ensure timely malnutrition diagnosis, care plan implementation, and care transition to next-in-line providers. The MQii interdisciplinary malnutrition Toolkit was designed to help clinicians reduce clinical practice variability in malnutrition care and advance evidence-based, patient-driven care for malnourished or at-risk hospitalized older adults.
The Toolkit and related resources were tested in a three-month intervention at Vanderbilt University Medical Center (VUMC). Additionally, 5 Learning Collaborative sites implemented it with limited support to reflect real-world circumstances. At the pilot’s conclusion, VUMC found that the Toolkit successfully improved malnutrition care (Table 1).
To accompany the Toolkit, 4 electronic clinical quality measures (eCQMs) evaluating malnutrition screening, assessment, care plan development, and diagnosis rates were created to assess malnutrition care quality provided by the multidisciplinary care team. The eCQMs offer care teams the ability to identify where care gaps remain and when they have successfully implemented best practices.
Hospitalists are increasingly held accountable for achievement of performance measures to demonstrate the value of care they provide. As malnutrition is an often overlooked risk factor, hospitalists can use the MQii Toolkit and eCQMs to help attain patient safety, patient engagement/satisfaction and resource use targets through clinical performance improvement and optimize patients’ chance at rapid recovery.
To cite this abstract:Fitall, E; Bruno, M; Jones, K; Lynch, J; Silver, H; Godamunne, K; Valladares, A; Mitchell, K. MALNUTRITION CARE: “LOW HANGING FRUIT” FOR HOSPITALIST CLINICAL PERFORMANCE IMPROVEMENT. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 157. https://www.shmabstracts.com/abstract/malnutrition-care-low-hanging-fruit-for-hospitalist-clinical-performance-improvement/. Accessed November 17, 2018.