May 18, 2020
The Dish
The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.
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SPOTLIGHT: UPDATED NATIONAL BLUEPRINT ON MALNUTRITION
- Improve quality of care practices
- Improve access
- Generate research
- Advance public health related to malnutrition
Your work improving care for patients and contributing to evidence generation through the Learning Collaborative are key activities to advance these goals.
This release is particularly timely amidst the COVID-19 pandemic, which has had a greater impact on the health and livelihood of older adults, and highlights the importance of healthy diets and food access in determining health outcomes. It is also a useful resource as 2020 is the first year of the World Health Organization’s Decade of Healthy Aging. Feel free to read the report for strategies that you may want to implement in collaboration with other healthcare, community, and policy partners to support better identification, management, and prevention of malnutrition for older adults.
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COVID-19 CORNER
As the pandemic continues to spread and increase demands on sites of care, the MQii Leadership Team is sharing resources for responding to COVID-19 to Learning Collaborative members. To best direct these efforts, we ask that you complete our brief “pulse check” so we can better understand your needs and challenges. We will use your responses (anonymously) to provide information, insights, and innovative practices to all MQii sites.
Here are a few other reminders and resources regarding COVID-19 that may be of use to you during this time:
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WHAT'S AROUND THE CORNER?
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Coffee Break: Malnutrition Care in the Era of COVID-19 | Monday, June 1 at 3:00 PM ET
Following our April COVID-19 Q&A Session, this conversation will provide an opportunity for small group discussion to share examples of successes and best practices for care in areas with both large and small COVID-19 patient populations.
Please register for the Coffee Break in advance here.
Expert Webinar: “Interactions Between Malnutrition and Gastrointestinal Disease” | Wednesday, June 10 at 11:00 AM ET
Join us on Wednesday, June 10, at 11:00 AM ET for the MQii Expert Webinar, “Interactions Between Malnutrition and Gastrointestinal Disease.” During this live webinar, participants will learn about:
- The connections between gastrointestinal (GI) diseases, diet, and nutritional status
- How GI diseases affect physiology and present in nutritional assessments
- Suggestions for providing optimal interdisciplinary care to meet nutritional needs for patients with GI diseases
The webinar will feature Gerry Mullin, MD, MS, Johns Hopkins Medicine, and Laura Matarese, PhD, RDN, LDN, CNSC, FADA, FASPEN, FAND, East Carolina University. Attendees will be eligible to receive a one-hour CPEU credit for their participation.
Please register for the webinar in advance here.
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Coffee Break: "How to Use Your MQii Performance Report to Improve/Expand Care Within Your Hospital” | Wednesday, July 29 at 1:00 PM ET
This conversation will provide an opportunity for Learning Collaborative members to discuss how collection and analysis of patient data can be used to improve or expand nutrition care for patients within your hospital. This will be particularly important as facilities begin to understand the impact of the current pandemic.
Please register for the Coffee Break in advance here.
For all of our expert webinars and Coffee Breaks, we encourage you to send any questions for the speakers in advance to [email protected].
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In case you missed it:
If you missed previous MQii Learning Collaborative expert webinars, you can access webinar recordings and slides on the MQii Member Portal. You will also find other member-only content, including the calendar of upcoming events, pre-recorded educational webinars, and archived Dish newsletters, on this site. As a reminder, the login information is: Username: MQii Password: MQiiLC2018!
Opportunity to Learn More about Learning Collaborative Data Findings
The 2020 AcademyHealth Annual Research Meeting (originally scheduled for June 13–16, 2020) has shifted to a virtual format to be held later this summer. Avalere plans to present two posters—“Piloting a Malnutrition Transitions of Care Program Coordinating Nutrition Care” and “Evaluation of the Variance Among Malnourished Patient Risk and Outcomes Related to Age, Race, and Gender from Hospital to Home”—based on findings from the MQii Learning Collaborative. We will share the times and venues for virtually viewing these posters once they become available.
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Consider opportunities to share your MQii project and findings!
The following table outlines several meetings and conferences that may be of interest to Learning Collaborative members in the coming months. We encourage you to look at the event websites, review submission criteria, and consider sharing your research with these various audiences. Please reach out with any questions or for assistance in pulling together submission materials.
As noted below, the Academy is now accepting late-breaking abstracts for FNCE 2020. If you have new MQii projects, interesting recent data, or new innovations (e.g., responses to the COVID-19 pandemic), consider developing and submitting an abstract for this late-breaking category. Please reach out with any questions or for assistance in pulling submission materials together.
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MALNUTRITION IN THE NEWS
Article Highlights Important Link Between Nutrition and Coronavirus Risk
A recent article in the New York Times, titled “How Poor Diet Contributes to Coronavirus Risk," brought national attention to the importance of improving metabolic health through nutrition to reduce risk of contracting and suffering from infectious disease. While improving nutrition for disease prevention may be most often associated with cardiovascular and metabolic health, the COVID-19 pandemic is shedding light on the importance of healthy diet and nutrition status on infectious diseases and the ability of our immune systems to keep us healthy. As these problems receive increased attention by the government, media, and citizens alike, continued quality improvement and data collection during and after this pandemic will be necessary to guide and inform necessary improvements to our healthcare and food systems.
Ireland Recommends Malnutrition Screening for All Inpatients
Ireland’s Department of Health recently published a National Clinical Guideline recommending that all patients admitted to the hospital be screened for malnutrition and that the screening be repeated weekly throughout their admission. The guideline lists related best practices, including providing training for screening for all nurses and hosting annual malnutrition awareness days to garner attention from providers, administrators, and patients. According a recent article titled, “All Inpatients to Be Screened for Malnutrition,” Irish hospitals are not screening consistently, meaning patients are at much greater risk of becoming malnourished and experiencing related negative health outcomes. The authors note that the prevalence of malnutrition is likely to be higher during the current pandemic, further elevating the importance of this practice.
CMS Programs Support Malnutrition Quality Improvement
The American Society for Aging recently published an article titled, “CMS Takes A Significant Step Forward to Help End Elder Malnutrition,” by Bob Blancato of Defeat Malnutrition today. The article explains the importance of clinical quality measures in tracking the quality of healthcare services. Two malnutrition clinical quality measures have been recently adopted in 2 Qualified Clinical Data Registries (QCDRs), which provide an ideal opportunity for clinicians (including RDNs) to track and report their quality improvement efforts. Mr. Blancato explains that an important next step is for CMS to approve malnutrition clinical quality measures in its hospital quality programs.
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LEARNING COLLABORATIVE PARTICIPANT RESOURCES
NFPE “Tip of the Month”
Reminder Why Albumin/Prealbumin and BMI Are Not Good Indicators of Nutrition Status
Albumin and prealbumin are negative acute phase reactants. These hepatic proteins decrease in response to inflammation, infection, injury, or trauma, making them poor indicators of nutrition status. In addition, individuals who are chronically malnourished without inflammation present (due to etiologies such as anorexia nervosa, calorie-restricted diets, or starvation) may not have decreased levels of albumin and/or prealbumin due to lack of sensitivity, further making them poor indicators of nutrition status.
While a low BMI can indicate malnutrition, having a normal or elevated BMI does not necessarily indicate a lack of malnutrition. The World Health Organization (WHO) developed BMI guidelines in 1999 that are primarily for children, as well as for adolescents and adults who are in “extreme privation and famine” in developing countries. In the United States, malnutrition can occur at any BMI. BMI alone does not indicate nutrition status for the acutely or chronically ill hospitalized patient or for the obese patient who consumes excessive calories (rather than nutrient-dense foods) in the United States.
Call for Data: Submit 2020 Performance Data by June 15, 2020 to Be Part of the 2020 MQii Performance Benchmark Report*
First MQii Performance Benchmark Report of 2020
Did you know? As a Tier 1-level participant in the MQii Learning Collaborative, you have the opportunity to contribute data on the malnutrition electronic clinical quality measures (eCQMs) and on patient outcomes that are benchmarked at the aggregate Learning Collaborative level. The performance benchmark report provides many benefits to Learning Collaborative participants, including:
- For all participants, the performance benchmark report provides insights to each individually enrolled hospital on its performance on the four malnutrition eCQMs as well as length of stay and 30-day readmissions based on its reported data.
- In addition, the report shows the average Learning Collaborative-wide performance for comparison in addition to stratification by hospital type and size for more direct comparison.
- The report includes previous years’ data to show how performance has changed in aggregate over time.
- There are helpful “star ratings” that show where an individual site’s performance falls along the range of performance.
- For multi-year participants, the benchmark report shows your average performance on the four eCQMs as well as patient length of stay and 30-day readmissions for malnourished patients and its evolution over time. Therefore, if you reported data in 2019, you will be able to see how your performance has changed since the previous reporting period.
Special Opportunity with COVID-19 Data for Performance Benchmark Report
As of April 1, 2020, COVID-19 has officially been classified with its own ICD-10 code for tracking COVID-19 diagnoses from patients who are hospitalized and infected with the novel SARS-Cov 2 virus. For each participant’s reporting of data, we also collect ICD-10 primary and secondary diagnoses codes for each encounter. Those data are useful because they may provide insights into the nutrition care that COVID-19 patients are receiving. Given the large impacts that COVID-19 has had across many U.S. health systems, we will include indicators that can provide early insights regarding the provision of nutrition care to COVID-19 patients.**
Therefore, all participants who contribute data after April 2020 will also receive calculated indicators for all patients with a COVID-19 diagnosis (primary or secondary). This information will provide a helpful window into the nutrition care these patients received and may inform each hospital’s efforts to improve care for COVID-19 patients.
Measuring the Impact of COVID-19 on Monthly Performance Data
We are aware that not all hospitals in the Learning Collaborative have been directly impacted by meaningful numbers of COVID-19 patients, but local/state/regional restrictions may lead to a major reduction in patient census. We will work with sites who report performance before stay-at-home orders as well as during the ongoing outbreak to compare those performance changes when identified in the monthly performance feedback reports. These data should provide a helpful look into how nutrition care may have been impacted during the months of the outbreak.
Please email Angel Valladares if you would like to contribute performance data prior to the deadline to participate in the performance feedback benefits outlined above.
*This request is only relevant to Tier 1 participating hospitals who have signed a Tier 1 participation agreement.
**This assumes sufficient minimum cases are available in the data reported to calculate performance indicators.
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NEXT STEPS
- Respond to our COVID-19 “pulse check” and visit the COVID-19 page on our website for more resources.
- Attend the upcoming June Coffee Break if you have questions regarding your malnutrition quality improvement efforts or want to discuss new or continuing malnutrition initiatives.
- Share your progress or reach out with any questions to your MQii Point of Contact. Please also let us know about any transitions in leadership, requested topics for future events, or additional events of interest to share with other members.
- Please sign and return your letter of intent/addendum to participate in the Learning Collaborative as soon as possible.
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