Learning Collaborative
 
October 27, 2020
The Dish
The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.
 
 
 
SPOTLIGHT: ADVANCEMENT OF MALNUTRITION COMPOSITE MEASURE

The MQii Leadership Team was pleased to learn in August that the Centers for Medicaid & Medicare Services (CMS) added the MQii Global Malnutrition Composite Score to its annual Measures under Consideration (MUC) List for measures that will be considered for inclusion in the Medicare Quality Payment Program (QPP). This composite measure reflects the steps included in the 4 malnutrition electronic clinical quality measures and was developed based on evidence generated through data from the Learning Collaborative. Going forward, the measures on the MUC List will undergo further review by CMS as well as by a National Quality Forum (NQF) workgroup. For more information, refer to the CMS pre-rulemaking website and this previous communication from the Academy, urging CMS to include this measure on the MUC List.

As the Academy and Avalere work to prepare a comment letter to send to CMS in support of this measure, we are seeking quotes from Learning Collaborative members that show the importance of efficient and effective malnutrition identification and management to bolster our letter. To offer an example, here is a quote we received from a Learning Collaborative member that spoke to the need for malnutrition identification, and was included in the comments to CMS when the original 4 malnutrition measures came up for review in 2018:

“Malnutrition can occur so quickly, and it's especially harmful and insidious with cancer patients. When a patient's malnutrition has been overlooked for months before diagnosis, it is almost impossible to recover from in combination with chemotherapy and radiation therapy. Malnutrition is not only damaging to the patient in and of itself, but also is an important indicator that other disease processes are occurring. When malnutrition is caught early, nutrition and medical interventions are more effective and the patient is able to come back from both malnutrition and cancer.”

We ask that you consider writing and sending us a brief quote that reflects your experience with the importance of malnutrition care. If you are able to provide a comment, please send it to Angel Valladares at [email protected] by November 13, 2020. Please also let us know if you have any questions.  
 
COVID-19 CORNER
 
 
As the pandemic continues, 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, including 2020 MQii Learning Collaborative Expert Webinars.

Expert Webinar: “Overcoming Challenges in Telehealth and Malnutrition Quality Improvement” | Tuesday, October 27, 2020, at 3:00 PM ET 

Join us on Tuesday, October 27th, at 3:00 PM ET for the MQii Expert Webinar, “Overcoming Challenges in Telehealth and Malnutrition Quality Improvement.” During this live webinar, which will reflect findings from the telehealth survey we recently administered to Learning Collaborative members, participants will learn about: 
  • Recent trends and policy changes related to telehealth use by clinicians, including registered dietitians   
  • Benefits and potential barriers to assessing and treating patients with malnutrition or those at risk using telehealth 
  • Additional resources and key contacts related to telehealth practices and policy  
This webinar will feature experts Wendy Everett, ScD, Senior Advisor at Avalere Health, and Cory Brunton, MSN, BSN, RN, Senior Analyst in Health Economics and Outcomes Research at Abbott. Attendees will be eligible to receive a one-hour CPEU credit for their participation. 

Please register for the webinar in advance here.  
Expert Webinar: “QCDR Malnutrition Measures Increase Opportunities to Document Standardized Malnutrition Care” | Tuesday, November 10, 2020, at 3:00 PM ET

Join us on Tuesday, November 10th, at 3:00 PM ET for the MQii Expert Webinar, “QCDR Malnutrition Measures Increase Opportunities to Document Standardized Malnutrition Care.” During this live webinar, participants will learn about: 
  • Malnutrition quality measures included in the Premier Clinician Performance Registry and the U.S. Wound Registry 
  • Steps involved in reporting the malnutrition quality measures using the Premier Clinician Performance Registry and the U.S Wound Registry to meet Merit-based Incentive Payment System (MIPS) reporting requirements  
This webinar will feature Catherine D’Andrea, RDN, LDN, Manager of Quality Initiatives at the Academy of Nutrition and Dietetics, and Angel Valladares, MPH, Research Scientist II at Avalere Health. Attendees will be eligible to receive a one-hour CPEU credit for their participation. 

Please register for the webinar in advance here.  

Coffee Break: “Barriers to Engaging Patients via Telehealth During COVID-19” | Monday, November 16, 2020, at 12:00 PM ET

This conversation will provide an opportunity for Learning Collaborative members to discuss the barriers they have faced and innovative solutions they have implemented to provide optimal care via telehealth during the COVID-19 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].
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. Please reach out with any questions or for assistance in pulling together submission materials.
 
 
 
MALNUTRITION RESEARCH

Weiler et al. recently published a paper titled, “Malnutrition and Frailty Screening in Older Adults,” that argues for the need for skills-based competency, education, and training in frailty screening and interventions for RDNs who work with older adults. Frailty is defined by reduced strength, endurance, and physiologic function and is associated with worsened patient outcomes. Based on survey responses from more than 900 RDNs, 90% were unfamiliar with frailty screening tools and only 6% said their facilities had policies for frailty screenings; however, 68% said that RDNs should play a leading role in frailty screening. To ensure that RDNs are equipped to best recognize and care for patients experiencing this condition as well as collaborate with interdisciplinary colleagues, practicing RDNs may wish to actively seek out professional development and education opportunities on this topic.  

Also, 4 posters presented at FNCE 2020 featured the MQii:  
LEARNING COLLABORATIVE PARTICIPANT RESOURCES

NFPE “Tip of the Month” 

Did you know one of the components of a nutrition focused physical exam (NFPE) is assessment of hydration status? 

When assessing a patient’s hydration status, look for both dehydration and overhydration: 
  • Dehydration: 
  • Check skin turgor by first pinching the skin on the forearm, below the clavicle, or on the abdomen and then releasing. The skin should return to normal after just a few seconds. If the skin tents, it may indicate dehydration. Note that tenting is a late sign of dehydration.  
  • Check capillary refill by applying pressure to the fingernail, turning it white. Release and the color should return within 3 seconds; if not, then dehydration may be present.  
  • Overhydration: 
  • Check for fluid accumulation/edema by pressing your thumb on the foot, ankle, and leg, as it is most often found in the lower extremities. Inspect for indentation and the time it takes for skin to rebound back to normal, which will indicate the grade of edema.  
The Academy’s NFPE Pocket Guide serves as a resource about the many NFPE components. 
NEXT STEPS
  • Visit the COVID-19 page on our website for more resources 
  • Attend the upcoming November 16 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