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The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.
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SPOTLIGHT: NEW RESOURCE ON NUTRITION QUALITY PROGRAMS AVAILABLE
- Basic information and resources (including pertinent quality measures) about value-based healthcare and quality programs across the continuum of care
- Opportunities for alignment with quality nutrition care
Information is categorized based on setting of care, including acute care, skilled nursing/long-term care, home health, specialty care, and private practice and office-based care. We encourage you to explore this website based on your clinical needs. The “Acute Care” section highlights MQii efforts, as well as other hospital-based activities that may be of interest to Learning Collaborative members. Also related to the MQii, you can refer to the “Specialty Care” and “Private Practice and Office-Based Care” headings to find information on the Quality Payment Program, within which you will find links to pages about the Merit-Based Incentive Payment System (MIPS) and the 2 Qualified Clinical Data Registries (QCDRs) that have malnutrition quality measures included for reporting. If you have any more questions about these programs, we encourage you to ask them at an upcoming MQii Coffee Break.
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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:
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To better understand the scope of projects being conducted by our Learning Collaborative members and potential opportunities to expand your reach, we would like to conduct a brief survey to gather information about whether and how you have expanded your QI projects to other sites in your healthcare system. We ask that you please respond with answers to the following questions to [email protected] by 12/7:
1. What is the name of your facility?
2. Is your institution part of a health system? If so, which one?
3. Did you expand MQii participation to other facilities in your health system?
- If so, how many facilities and what are their names?
- If not, what are the primary barriers to doing so?
4. Do you plan to expand MQii participation to other facilities in your system in 2021?
- If so, how many facilities and what are their names?
- If not, what are the primary barriers to doing so?
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WHAT'S AROUND THE CORNER?
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Expert Webinar: “Opportunities to Address Malnutrition in Post-Acute Care Settings” | Thursday, December 10, 2020, at 3:00 PM ET
Join us on Thursday, December 10, at 3:00 PM ET for the MQii Expert Webinar, “Opportunities to Address Malnutrition in Post-Acute Care Settings.” During this live webinar, participants will learn about:
- Ways in which malnutrition can manifest in various settings of post-acute care
- Various roles of registered dietitians in different settings of post-acute care, including for treatment and prevention of malnutrition, and how they can best coordinate with acute and other care settings as patients transition between settings
- Opportunities to adapt and implement clinical tools in new settings to improve care quality related to malnutrition
This webinar will feature Rya Clark, RDN, LD, CNSC, Clinical Nutrition Manager at TIRR Memorial Hermann, and Jen Bruning, Director of Nutrition and Brand Innovation at Incite Strategic Partners, LLC. 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: “Integrating Nutrition into ERAS Programs During COVID-19” | Wednesday, December 16, 2020, at 2:00 PM ET
Many of our members are working on better integrating nutrition care into Enhanced Recovery After Surgery (ERAS) programs in their hospitals. This conversation will provide an opportunity for small group discussion to share examples of successes and best practices for gaining nutrition-related support from other disciplines as well as any additional challenges posed by 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].
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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!
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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.
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MALNUTRITION RESEARCH
Khanimov et al. recently published a review paper titled, “Hypoglycemia, Malnutrition and Body Composition,” that describes specific characteristics of patients at risk of hypoglycemia and treatments that can prevent it. The authors note that nutritional status at admission and during a hospital stay is a major risk factor for hypoglycemia. They assert that assessing nutritional status can help to determine risk of hypoglycemia and that subsequent interventions for malnutrition can reduce that risk. This suggests that the malnutrition quality improvement projects you are completing can also be important opportunities to prevent dangerous and expensive hypoglycemic episodes within your hospitals.
Additionally, Dijkink et al. published a systematic review titled, “Malnutrition and its effects in severely injured trauma patients,” that describes the current knowledge about the pathophysiology, prevalence, and effects of malnutrition in hospitalized patients with severe injury. Among articles they reviewed, the authors found that the prevalence of malnutrition ranged widely from 7–76% in severely injured patients. Within the geriatric population, 7–62.5% were malnourished and 35.6–60% were at risk for malnutrition upon admission. Further, malnutrition was an independent risk factor for complications, mortality, prolonged hospital length of stay, and reduced quality of life. The authors concluded that while nutritional status of severe trauma patients should be carefully monitored for malnutrition, available evidence for this review was low-quality and limited—suggesting the need for more research to generate evidence, such as that conducted by members of the MQii Learning Collaborative.
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MALNUTRITION IN THE NEWS
The connection between malnutrition and COVID-19 was featured in a recent news story titled, “House Call: Negative Consequences of Malnutrition,” which included an interview with Wendy Phillips, MS, RD, CNSC, CLE, NWCC, FAND, Vice Chair of the Malnutrition Committee for the American Society for Parenteral and Enteral Nutrition (ASPEN). This public-facing story covered the negative consequences of malnutrition, the hospitalized patient populations with higher rates of malnutrition, and summary information on malnutrition and COVID-19 patients. This story offered an opportunity to raise awareness of the issue among the public and direct them to useful, evidence-based resources.
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LEARNING COLLABORATIVE PARTICIPANT RESOURCES
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Call for Data: Submit 2020 Performance Data by December 15, 2020, to Be Part of the 2020 MQii Performance Benchmark Report*
Second MQii Performance Benchmark Report of 2020
Tier 1-level participants in the MQii Learning Collaborative 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 4 malnutrition eCQMs, 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 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 4 eCQMs, patient length of stay, and 30-day readmissions for malnourished patients and its evolution over time. So if you have reported data previously, 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 SARS-CoV-2. For each participant’s reporting of data, we also collect ICD-10 primary and secondary diagnoses codes for each encounter. Those data 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 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
While not all hospitals in the Learning Collaborative have been directly impacted by meaningful numbers of COVID-19 patients, local, state, and 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 will show how nutrition care has been impacted during 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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Transitions of Care Presentation
ANHI hosted a presentation titled, “Utilizing the Malnutrition Quality Improvement Initiative (MQii) to Strengthen Transitions of Care” for the Clinical Nutrition Management Dietetic Practice Group symposium earlier this year. The webinar featured Learning Collaborative members Angela Lago and Skip Allen from New Hanover Regional Medical Center and Angel Valladares from the MQii Leadership Team. The speakers focused on data capture, the role of RDNs in leading interdisciplinary teams to improve patient outcomes, and implementation of an RDN in-home approach to improve outcomes across transitions of care. The recording is now free to view online and includes 1 CPEU credit.
National Blueprint Podcast
Kristi Mitchell from the MQii Leadership Team and Meredith Whitmire from Defeat Malnutrition Today were recently featured in a podcast about the National Blueprint: Achieving Quality Malnutrition Care for Older Adults, 2020 Update, hosted by ANHI. The updated Blueprint was released in May 2020 as older adult malnutrition persists as a growing crisis in America and is exacerbated by a global pandemic that has intensified health disparities and social isolation. It shared strategies to improve health outcomes for older adults by addressing malnutrition care across the continuum of acute, post-acute, and community settings, directed at a variety of stakeholders ranging from policymakers to patients and caregivers. In this podcast, Kristi and Meredith discuss topics such as how the 4 goals in the Blueprint can be accomplished, achievements seen in malnutrition policies over the past 10 years, and the important roles of data in a malnutrition quality improvement program.
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NFPE “Tip of the Month”
Did you know that a dynamometer can be used to measure handgrip strength to assess functional status related to malnutrition?
What makes it a good measurement tool?
- Objective indicator of functionality that is highly sensitive for identifying malnutrition
- Reliable testing tool when standardized methods and calibrated equipment are used in combination with reference ranges based on gender, age, and handedness that are provided with the dynamometer model
- Quantified by measuring the amount of static force that the hand can squeeze around the dynamometer
- Shows earlier response to nutritional changes than labs or anthropometrics
What are the general criteria for malnutrition indicators?
- According to the Academy/ASPEN Malnutrition Consensus Statement, reduced grip strength is 1 of the 6 malnutrition characteristics
- A measurably reduced grip strength is indicated as a severe malnutrition characteristic
- Note that it is not applicable for a moderate malnutrition diagnosis at this time
- A measurement of 2 standard deviations below the mean is considered outside of the normal limits and thus indicates reduced grip strength
- If reduced, the dietitian must monitor the trend upon follow-up visits
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NEXT STEPS
- Visit the COVID-19 page on our website for more resources
- Attend the upcoming December 16 Coffee Break if you have questions regarding your malnutrition quality improvement efforts or want to discuss new or continuing malnutrition initiatives. You may also attend our upcoming webinar to learn more about addressing malnutrition in post-acute settings and opportunities to collaborate with RDNs in those settings
- 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
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