Learning Collaborative
 
August 24, 2020
The Dish
The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.
 
 
 
SPOTLIGHT: ADVANCEMENT OF THE MEDICAL NUTRITION THERAPY ACT

Following the May introduction of the Medical Nutrition Therapy Act of 2020 in the House, Senators Susan Collins and Gary Peters recently released its companion bill in the Senate. The bill would expand access to MNT beyond Medicare beneficiaries with diabetes and kidney disease to those with conditions such as prediabetes, dyslipidemia, cancer, and malnutrition. The bill would also allow the US Secretary of Health and Human Services to further expand access to MNT without additional legislation from Congress and allow PAs, NPs, clinical nurse specialists, and psychologists to refer patients for MNT. The Academy continues to ask that dietitians share stories highlighting the impact of MNT in treating and preventing diseases/conditions that would be covered under the MNT Act of 2020. If you would like to learn more, Academy members can view the recording of a July 7th webinar on this topic and corresponding slides. Should you be interested in more information on this bill or would like to engage in this opportunity, please reach out to the Academy’s Policy Initiatives and Advocacy team at [email protected].
 
 
 
COVID-19 CORNER

As the pandemic continues to spread, the MQii Leadership Team is compiling resources about responding to COVID-19 for Learning Collaborative members. Here are a few resources and updates that may be of use to you during this time:
WHAT'S AROUND THE CORNER?
Please check the MQii Learning Collaborative Calendar to see a schedule of upcoming events with corresponding registration links.

August Coffee Break: Best Practices for Malnutrition Care Amidst Changing Roles of Dietitians | Monday, August 24, 2020, at 3:00 PM ET

This conversation will provide an opportunity for Learning Collaborative members to discuss how the COVID-19 pandemic has forced dietitians in many settings across the country to adjust their practices and roles to meet patients’ needs, and how these might be continued to improve patient care going forward. 

Please register for the Coffee Break in advance here. 

September Coffee Break: Preparing for a Potential Second Wave of COVID-19 and Changes to Nutrition Care | Monday, September 14, 2020, at 3:00 PM ET

This conversation will provide an opportunity for Learning Collaborative members to discuss how they are preparing for potential increases in patient populations and changes to their operations in anticipation of a second wave of COVID-19 (or how they have responded to a current surge). Participants will discuss how they can best optimize malnutrition assessments, interventions, and prevention during this time. 

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].
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!
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. While many 2020 conferences have either been cancelled, rescheduled, or moved to a virtual setting, we encourage you to still participate when possible. Please reach out with any questions or for assistance in pulling together submission materials.
 
 
 
MALNUTRITION RESEARCH

Article Reflects Real-World Impact of Nutrition Care

Members of the MQii Leadership Team recently published an article, "Nutrition Interventions Deliver Value in Healthcare: Real-World Evidence," in Nutrition and Dietary Supplements. This article reviews evidence of the negative effects of malnutrition on health and costs of care, offers examples of effective nutrition-focused quality improvement programs within hospitals (including many within the MQii Learning Collaborative), and outlines the potential implications to clinical care and nutrition policy of better adherence to these best practices. Overall, the authors note that improved health outcomes for hospitalized patients who benefit from high quality nutrition care can reduce overall costs of care and demonstrate value, which is increasingly gaining the attention of healthcare decision makers worldwide. 

Articles Highlight Prevalence and Association Between Malnutrition and Specific Comorbidities

A recent study by Roubìn et al. found that malnutrition is common among patients with acute coronary syndrome (ACS) and is strongly associated with increased mortality and cardiovascular events after multiple years of follow-up. In their article, "Prevalence and Prognostic Significance of Malnutrition in Patients with Acute Coronary Syndrome," the authors describe their retrospective study of 5,062 Spanish patients that utilized tools such as the Controlling Nutritional Status (CONUT) score, the Nutritional Risk Index (NRI), and the Prognostic Nutritional Index (PNI), and GRACE (Global Registry of Acute Coronary Events) risk score to look at both malnutrition and its associated outcomes. Since this was a retrospective study, the authors concluded that prospective clinical trials to further confirm these findings are needed. Freeman and Aggarwal further highlighted the implications of this study for patients with obesity—a condition that can be closely connected to malnutrition but is often overlooked—in their editorial, "Malnutrition in the Obese: Commonly Overlooked But With Serious Consequences."

Articles Discuss Importance of Evaluating Malnutrition Screening and Assessment Tools 

Two recent articles shared the results of studies focused on tools to improve malnutrition detection and diagnosis. Timsina et al. recently published a paper, "MUST-Plus: A Machine Learning Classifier That Improves Malnutrition Screening in Acute Care Facilities," to describe their process and goals for creating a classifier (which is the function that would assign the label of malnutrition) called MUST-Plus, based on the Malnutrition Universal Screening Tool (MUST) and a process that uses machine learning to improve accuracy of predicting malnutrition. Using a retrospective inpatient cohort, the authors found that using the MUST-Plus significantly increased the sensitivity, specificity, and area under the curve (indicative of diagnostic accuracy) compared to the classic MUST, highlighting the potential to improve dietitians’ efficiency through faster referrals of high-risk patients. Further, Burgel et al. published a paper, "Concurrent and Predictive Validity of AND‐ASPEN Malnutrition Consensus is Satisfactory in Hospitalized Patients: A Longitudinal Study," reflecting additional data suggesting the satisfactory concurrent and predictive validity of the malnutrition characteristics presented in the AND-ASPEN Consensus Statement. The authors evaluated assessment and outcomes data from 600 patients and compared diagnoses between the Subjective Global Assessment (SGA) and AND-ASPEN criteria (both with and without handgrip strength). These findings provide further evidence to support the screening and assessment practices of most members of the Learning Collaborative. 
CURRENT ENGAGEMENT OPPORTUNITIES

Telehealth Survey: Request for Readers

We are asking Learning Collaborative members to please complete this brief telehealth survey so we can better understand your strategies, goals, and barriers related to telehealth and nutrition. This should take less than 20 minutes of your time. We hope to learn more about whether and how Learning Collaborative facilities deployed telehealth in response to the COVID-19 pandemic and will use your responses (anonymously) to provide information, insights, and innovative practices to MQii sites and potentially other healthcare facilities through dissemination opportunities. Even if your facility has not significantly used telehealth, this is an important finding and we request that you complete the survey, as well.

Malnutrition Advocacy Webinar

The Academy and Defeat Malnutrition Today (DMT) hosted a webinar titled, "Rise Up! The Power of State Advocacy for Malnutrition," on 8/19. As many of you have expressed interest in policy change to improve prevention and treatment of malnutrition, we encourage you to watch the webinar recording and/or review the corresponding slides to learn more. Please email [email protected] with any questions. 

Surgical Care Engagement Opportunity

For those of you who are members of the Academy and an affiliated Dietetic Practice Group (DPG), you are asked to please send comments regarding the AHRQ Safety Program for Improving Surgical Care and Recovery to your DPG Policy and Advocacy Leader by 9/7 so that they can be compiled and submitted by the end of September. This quality improvement project aims to assist hospitals in implementing evidence-based practices to improve patient outcomes following surgery. As many of you are actively working to improve nutrition care in surgical settings, please let us know if you engage to learn more about this program or are otherwise working with AHRQ on this opportunity.  
MALNUTRITION IN THE NEWS

Following last month’s report from the Office of the Inspector General (OIG) estimating that hospitals overbilled Medicare by almost $1 million by incorrectly assigning severe malnutrition diagnosis codes to inpatient hospital claims in fiscal years 2016 and 2017, the Academy—together with ASPEN, the Association of Clinical Documentation Integrity Specialists (ACDIS), and the American Society for Nutrition (ASN)—have released a joint statement in which they express concern about the lack of transparency around the auditors’ criteria and what should be the precise, correct criteria for diagnosing and coding severe malnutrition. These organizations continue to emphasize the importance of thorough documentation to support a diagnosis of malnutrition and the associated intervention(s) and collaboration with providers to ensure consistent documentation.
LEARNING COLLABORATIVE PARTICIPANT RESOURCES

NFPE “Tip of the Month” 

What are some physical signs that may indicate a vitamin C deficiency?

When performing a nutrition focused physical exam (NFPE), you may detect a vitamin C deficiency by looking for abnormalities of the hair, oral cavity, nails, and skin. One or more of the abnormalities/signs that may be present are:
  • Corkscrew hair (coiled hair)
  • Scorbutic gums (swollen, redness in the triangle-shaped area between the teeth and lip; bleeding gums)
  • Scorbutic tongue (petechiae on the surface of the tongue)
  • Splinter hemorrhage (reddish brown linear streaks that run in the direction of the nail)
  • Perifollicular hemorrhage (small hemorrhages due to frail capillary wall)
Conditions that may lead to risk of vitamin C deficiency include limited diet, wounds, infant consumption of cow's milk, dialysis, malabsorption, and smoking.
NEXT STEPS
  • Complete the telehealth survey mentioned in the "Current Engagement Opportunities" section above.
  • Visit the COVID-19 page on our website for more resources.
  • Attend today's August Coffee Break if you have questions regarding your malnutrition quality improvement efforts or want to discuss new or continuing malnutrition quality improvement programs. 
  • 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.