Learning Collaborative

March 29, 2019

The Dish

The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.

Spotlight: Highlighting Transitions of Care Innovations in the MQii Learning Collaborative

Learning Collaborative Sites Address Gaps in Transitions of Care

In late 2018 and in early 2019, the MQii Team fielded a survey to Learning Collaborative participants regarding nutrition-related discharge planning activities and pre-admission nutrition activities. We received responses from over 25 Learning Collaborative sites, highlighting an exciting range of innovative tactics that address malnutrition-related transitions of care processes. Based on responses to the survey, we conducted a subset of interviews with sites who had insightful stories to share. Overall, the two main trends from these interviews included:

1. The use of tailored meal delivery for malnourished patients in the home; and
2. A program for malnourished patients to help bridge the gap between the care they receive in the hospital and what is experienced once they return home.

For example, New Hanover Regional Medical Center (NHRMC) is implementing an initiative to provide nutrition to malnourished patients who have limited access to food through the use of a clinical outreach dietitian and a discharge nutrition food box. When patients are diagnosed as malnourished by a registered dietitian (RD) at NHRMC, specific nutrition interventions are put into place to meet each patient’s medical nutrition needs. The care plan is designed to help patients improve and teach them how to properly nourish themselves when they are discharged. However, until now, the clinical nutrition services team did not know if patients had access to nutritious food once they left the hospital, or if they were able to follow the care plan that was created specifically to help them rebuild strength. The initiative put in place allows NHRMC to work with a clinical outreach dietitian who visits malnourished patients in their homes to reinforce their nutrition plan of care and ensure they get connected to the resources they need to continue recovering at home. Additionally, patients receive a discharge nutrition food box to support their continued recovery. The NHRMC Nutrition Services team selected items for the food boxes, which include peanut butter, lean protein, granola bars, whole wheat bread, fruit and other staple items. 

Similarly, Legacy Health is implementing a grant-funded program where the registered dietitian nutritionist (RDN) identifies malnourished patients when they are discharged to their home and then works with the hospital to provide three nutritionally-tailored meals to the patient for four weeks post-discharge. The discharge meal provision delivery pilot started with 15 patients, and Legacy Health is working to expand it to many more patients in the hospital. 

If you were unable to contribute to the survey but have an interesting discharge/transitions of care effort planned or underway to share, please reach out to your MQii Team Point of Contact to share your experience and insights! 

JAND Supplement

Feature Your Project in the MQii-Focused Journal of the Academy of Nutrition and Dietetics (JAND) Supplement

Consider submitting your abstract(s) to the MQii-focused Supplement of the Journal of the Academy of Nutrition and Dietetics (JAND), to be released in September 2019! The Supplement intends to highlight MQii stories and Learning Collaborative member findings. The Supplement will be peer-reviewed and is being led by the Academy and Avalere, with support provided by Abbott. The submission portal will be open April 3-April 18, 2019. 

Abstracts should be based on experiences with and/or use of the malnutrition electronic clinical quality measures (eCQMs) and/or the MQii Toolkit or other quality improvement frameworks, and be relevant to malnutrition in the adult acute care population. Abstracts should align with and be submitted for one of the following three categories of malnutrition focus areas: 

1. Multidisciplinary team engagement and key learnings from implementing a clinical malnutrition-related quality improvement process or program.
2. Data integration and process outcome results from implementing a clinical malnutrition-related quality improvement process or program.
3. Research outcome results from implementing a clinical malnutrition-related quality improvement process or program. 

We urge all Learning Collaborative hospitals to consider submitting an abstract. Even if you are just starting your journey, you can share your early learning experiences and your work to build a multidisciplinary team. As you start to outline your abstract, please reach out to your MQii Point of Contact as soon as possible. All abstracts will be submitted electronically via an MQii JAND Supplement submission website; we will circulate a link to the portal via email after it goes live on April 3^rd. Please find additional details regarding submission requirements and abstract templates here. For questions or further information, contact [email protected].

Nutrition in the News

Blue Cross Blue Shield Institute and Health Care Service Corporation Begin Food Delivery Program

Recently, the Blue Cross Blue Shield (BCBS) Institute and Health Care Service Corporation (HCSC) announced a new initiative titled “foodQ” to provide a healthy food delivery service that brings meals directly to people living in areas considered to be “food deserts,” known for lacking adequate access to fresh foods that make up a healthy diet. Through the service, the companies will offer consumers easy access to affordable, nutritious foods to improve their health outcomes, particularly for diet-related, chronic conditions, while reducing avoidable emergency room visits and hospital readmission rates. The BCBS Institute will pilot foodQ in 25 Chicago zip codes and 15 Dallas zip codes where HCSC operates health plans. Any consumer living in these zip codes can participate, regardless of health insurance status or insurance carrier. The concept around using nutrition (e.g., food delivery) to address health needs and prevent healthcare utilization is part of an overarching movement toward addressing social determinants of health. Other insurers including Anthem, Cigna, Humana, UnitedHealth Group and CVS Health, which owns Aetna, are starting to pursue initiatives in this space.

Learning Collaborative Participant Activities

American Society for Parenteral and Enteral Nutrition (ASPEN) 2019 Nutrition Science & Practice Conference Highlights Three MQii Learning Collaborative Sites

The ASPEN 2019 Nutrition Science & Practice Conference took place in Phoenix, AZ on March 23-26. This event, which engages more than 2,000 participants annually, provides nutrition support professionals with current and cutting-edge information in the fields of nutrition support, clinical nutrition, and metabolism. This year, Jennifer Wills from the University of North Carolina and Angela Lago from New Hanover Regional Medical Center presented their experiences and results from their MQii projects. During their roundtable presentation, Angela and Jennifer described their processes for designing two unique but similar approaches for implementing malnutrition transitions of care pilots to better manage the nutrition needs of patients who are identified as malnourished while in inpatient care, through the discharge process and following discharge. Jennifer also delivered a panel presentation highlighting UNC Chapel Hill’s experience improving registered dietitian (RD) assessment rates for patients at-risk of malnutrition and improved documentation of medical diagnoses of malnutrition. Last, Gerry Howick from Legacy Health showcased a poster at ASPEN titled “An Audit Using Nutrition Focused Physical Exam by Registered Dietitians Indicates Twenty-Eight Percent of Patients in a Community Hospital to be Malnourished.”

ThedaCare Nutrition Risk Screen Seeks Interest from Other MQii Learning Collaborative Sites

In January, ThedaCare published on its newly developed nutrition risk screening (NRS) tool in the Journal of Parental and Enteral Nutrition. The tool, the ThedaCare NRS, was tested in non-intensive care units at ThedaCare Regional Hospitals and was found to improve the accuracy of identification of patients at moderate and high risk for malnutrition in less time when compared with the Nutrition Risk Screen 2002 (a validated screening tool). ThedaCare is interested in partnering with any site that is looking to improve their screening process and is also willing to help any site that is currently using the NRS but is not satisfied. They are also available to help any sites who are using the malnutrition screening tool (MST) or the malnutrition universal screening tool (MUST) but are encountering a high number of false-positives. If any MQii Learning Collaborative sites are in need of the “how-tos” regarding improved screening processes, please contact Lori Hartz for more information.

 What's Around the Corner?

Upcoming Conferences and Events

European Society for Clinical Nutrition and Metabolism Accepting Submissions

Consider submitting an abstract for a poster on your malnutrition quality improvement project to the European Society for Clinical Nutrition and Metabolism (ESPEN) 41^st Congress! The event will be held in Krakow, Poland from August 31 – September 3, 2019. The submission deadline is April 5^th, 2019 at 5:00PM ET. For more information, visit the ESPEN Congress website.

Next Steps 

• Reach out to your MQii Point of Contact if you are interested in developing an abstract for the special JAND Supplement!
• Consider reviewing general dissemination guidance provided in the February 13 dissemination webinar or the March 1 dissemination webinar for more information on the JAND Supplement opportunity
• Attend an upcoming Coffee Break if you have questions regarding your malnutrition quality improvement efforts
• Coffee Breaks are open-format, interactive sessions that allow participants to discuss particularly challenging questions around engaging their IT teams and preparing for eCQM and outcomes data extraction in addition to QI project support. Participants are encouraged to attend and bring their questions, suggest ideas to other participants who are encountering obstacles, or just listen in and be inspired by the discussion. Use the link below to register for the next Coffee Break:
• Monday, April 1 at 2:00PM ET
• Share your progress with your MQii Point of Contact – we want to hear about any developments you’ve experienced, as well as any challenges you might be encountering!
• Fill out your Project Charter once you identify plans for your malnutrition quality improvement project(s)
• Watch the educational videos and expert webinar recordings available on the MQii Member Portal (log in information— Username: MQii Password: MQiiLC2018!) and explore the resources in the MQii Toolkit