June: The Dish provides a monthly update to participating sites enrolling in the MQii Learning Collaborative.
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Learning Collaborative
June 25, 2019
The Dish
The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.
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Spotlight: New Evidence Emphasizes the Value of and Opportunities for Improved Malnutrition Care
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New Research Highlights the Usability of Malnutrition Diagnostic Criteria, Barriers to Malnutrition-Related Care in the Acute Care Setting, Nutrition-Related Discharge Planning Recommendations, and Benefits of a Home Health Nutrition-Focused Quality Improvement Program
New studies and resources continue to be disseminated in high-impact medical journals reflecting research on the effect of malnutrition on patients and opportunities to improve malnutrition care within and beyond acute care settings. Some examples include:
- The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) recently published a study reviewing available literature on the usability, feasibility, validity, and reliability of the Academy/ASPEN malnutrition diagnostic criteria in both adult and pediatric populations, as well as evaluating their use in studying clinical outcomes. The authors found that the evidence particularly supports the usability, feasibility, and reliability of the criteria in adult populations. Additionally, both the adult and pediatric tools have shown significant correlation with negative clinical outcomes in malnourished patients, including increased mortality, increased hospital length of stay (adults), increased complications (pediatrics), and increased hospital readmissions.
- In April, R. Chambers et al. published an article in the Journal of Nutrition in Clinical Practice highlighting gaps in the care of malnourished patients on general medicine floors in acute care settings. The authors hypothesized that the three main gaps in care were poor dietitian-doctor communication, excessive time spent nil per os (NPO) for procedures and testing, and/or inaccurate or incomplete dietary discharge instructions. Chart reviews found that 76% of malnourished patients had at least one gap in care. The article highlights the need to develop strategies to improve care components such as discharge documentation and time spent NPO to provide the best and safest nutrition care.
- Limited studies exist on how often and what type of nutrition care instructions should be given at discharge. Earlier this year, M. Brooks et al. published an article in the Journal of Human Nutrition and Dietetics examining the electronic medical record for discharge nutrition care instructions provided to adult patients, identified by dietitians as malnourished, over a 4-month period. The authors determined that most malnourished patients receive inappropriate or inadequate nutrition care instructions upon discharge and recommend clinical education and redesign of nutrition care options and workflows in the EMR to better manage malnutrition after patients leave the hospital.
- As post-acute care becomes one of the fastest-growing areas of healthcare spending in the United States, increased attention is being placed on ways to cut costs and improve health outcomes in post-acute care settings. In June, K. Riley et al. published an article in the Journal of Parenteral and Enteral Nutrition reviewing the impact of a nutrition-focused quality improvement program (QIP) on hospitalization rates and healthcare costs, conducted in a home health agency over a 90-day period. The authors found that the intervention led to reduced relative risk of hospitalization post‐enrollment in the QIP by 24.3%, 22.8%, and 18.3% at 30, 60, and 90 days, respectively. The article highlights growing evidence that suggests identification and treatment of malnutrition can help yield improved health outcomes and significant cost savings.
If you have any questions or would like to talk about these developments further, reach out to your MQii Point of Contact!
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Learning Collaborative Participant Resources
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Collecting Your Data and Measuring Your Progress
Many of you have been requesting MQii resources related to processes involving data collection and measuring the progress of your malnutrition quality improvement projects. Please see below for links to a few helpful resources on this topic. As always, do not hesitate to reach out to your MQii Point of Contact for additional information!
- Video: How to Transition from Tier 2 to Tier 1: Reviews the process and key considerations for transitioning to a Tier 1, or data collecting, site
- Educational Webinar: Establishing Your Data Collection Process (featuring Ken Nepple, MD, FACS, Clinical Associate Professor in the Department of Urology at the University of Iowa Hospitals and Clinics): Provides guidance on the Electronic Clinical Quality Measure (eCQM) Performance Calculator and the MQii Data Management Guide as well as best practices for identifying when in your project lifecycle you should have a data collection process established
- Sections of the MQii Toolkit:
- Select Your Quality Improvement Focus: Shares tips on how to map your organization’s existing clinical workflow and help you determine your project focus (clinical improvement to implement)
- Plan for Data Collection: Highlights best practices for tracking the impact of your improvement activities and reviews eCQMs and quality indicators
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What's Around the Corner?
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Expert Webinar: Acute Care to Next Site of Care Hand Offs: Continuation of the Nutrition Plan, Documentation, Intervention and Implementation | Tuesday, June 25 at 2:00 PM ET (TODAY!)
Join us on Tuesday, June 25 at 2:00 PM ET (TODAY!) for the MQii Expert Webinar, “Acute Care to Next Site of Care Hand Offs: Continuation of the Nutrition Plan, Documentation, Intervention and Implementation.” During this live webinar, participants will have an opportunity to hear about the barriers and challenges to effective communication from the inpatient setting to the next setting of care; ways to identify opportunities to support better care coordination across settings; and hear a successful example from a hospital that has implemented a program and improved patient outcomes.
Attendees will be eligible to receive one-hour CPEU credit for their participation.
The webinar will feature Angela Lago, MS, RD, LDN, CNSC, Clinical Nutrition Manager at New Hanover Regional Medical Center in Wilmington, North Carolina.
Please register for the webinar in advance here.
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Expert Webinar: Improving Nutrition Care for Surgical Patients: Pre-Admission through Inpatient Stay Recommendations | Tuesday, July 16 at 2:00 PM ET
Join us on Tuesday, July 16 at 2:00 PM ET for the MQii Expert Webinar, “Improving Nutrition Care for Surgical Patients: Pre-Admission through Inpatient Stay Recommendations.” During this live webinar, participants will have an opportunity to hear about ways to identify the increased risks of malnutrition or nutritional decline for surgical patients; obtain best practices to support nutrition care for surgical patients from pre-admission through discharge; and discuss opportunities to partner with surgical leaders in your facility for better nutrition care.
Attendees will be eligible to receive one-hour CPEU credit for their participation.
The webinar will feature Ken Nepple, MD, FACS, Clinical Associate Professor in the Department of Urology at the University of Iowa Hospitals and Clinics and Ashley Matthews, MS, RDN, LD, CNSC, PMP, Clinical Nutrition Lead at WellStar Kennestone Regional Medical Center.
Please register for the webinar in advance here.
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Expert Webinar: Optimization of the EHR for Nutrition Care | Wednesday, August 7 at 3:00 PM ET
Join us on Wednesday, August 7 at 3:00 PM ET for the MQii Expert Webinar, “Optimization of the EHR for Nutrition Care.” During this live webinar, participants will have an opportunity to hear about ways to identify the benefit of and the barriers to documenting nutrition care using the EHR; discuss how to capture key components of the nutrition care process in the EHR; and review opportunities to partner to troubleshoot nutrition data-related EHR limitations. More specifically, participants will hear insights on how to extract nutrition data from two EHR platforms, EPIC and Cetner, and can ask speakers questions about how they modified their EHRs to collect nutrition-related information of interest.
Attendees will be eligible to receive one-hour CPEU credit for their participation.
The webinar will feature Curt Calder, MBA, RDN, CD, Solutions Analyst in Care Transformation at Intermountain Healthcare and Cass Kight, PhD, RDN, CNSC, Clinical Nutrition Specialist at University of Wisconsin Health System.
Please register for the webinar in advance here.
For all of our expert webinars, we encourage you to send any questions you have for the speakers in advance of the webinar to [email protected]. We hope you can join us!
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Consider opportunities to share your MQii project and findings!
Conference on the Science of Dissemination and Implementation in Health Now Accepting Submissions
Consider submitting an abstract to present your malnutrition quality improvement project at the 12th Annual Conference on the Science of Dissemination and Implementation in Health, hosted by AcademyHealth! The conference’s theme this year is “raising the bar on the rigor, relevance, and rapidity of dissemination and implementation science.” The event will be held in Arlington, Virginia from December 4-6, 2019. The submission deadline is Tuesday, July 16, 2019 at 5:00 PM ET. For more information, visit the Frequently Asked Questions (FAQ) page.
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Next Steps
- Attend upcoming webinars and Coffee Breaks if you have questions regarding your malnutrition quality improvement efforts
- Coffee Breaks are open-format, interactive sessions that allow participants to discuss their interventions and receive QI project support, as well as address any challenging questions related to eCQM and outcomes data extraction. 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:
- Share your progress or reach out with any questions you have to 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)
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