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The Dish provides a quarterly update to participating sites enrolled in the MQii Learning Collaborative.
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AT A GLANCE
- Attend the upcoming June 29 Coffee Break if you have questions regarding your malnutrition quality improvement efforts or want to discuss new or continuing malnutrition initiatives
- For data-sharing members, submit your data to Angel by July 31 to receive your first 2021 performance benchmark report
- Consider submitting comments on the importance of quality improvement and measurement in malnutrition assessment and treatment for the IPPS proposed rule and AHRQ draft systematic review on malnutrition
- 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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SPOTLIGHT: ADVANCEMENT OF THE GLOBAL MALNUTRITION COMPOSITE SCORE
We are pleased to share that our malnutrition composite measure has received recommended endorsement from the NQF Prevention and Population Health Committee. NQF will make its final endorsement decision by the end of June and we will update you with a news story on our website. To read more about the development and endorsement process for this measure, you can visit this article we published in JAND earlier this year.
Despite anticipated NQF endorsement, the composite measure was not included in this year’s Inpatient Prospective Payment System (IPPS) proposed rule for reporting in the Hospital Inpatient Quality Reporting (IQR) Program. However, CMS is accepting comments on this action through June 28. If you are interested in submitting comments, please let us know as soon as possible so we can support you to develop and submit a comment letter. Regardless of this outcome, we continue to hope that NQF will endorse the measure to increase the likelihood of its use in the IQR program in the future.
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As the pandemic continues, the MQii Leadership Team is compiling resources about responding to COVID-19 for Learning Collaborative members. This will be our last “COVID-19 Corner” in the quarterly Dish; however, we will continue to make relevant materials available on the MQii website should you be interested in evidence and guidance on COVID-19 and nutrition care. Here are a few resources and updates that may be of use to you in the meantime:
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WHAT'S AROUND THE CORNER?
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Coffee Break: “Meeting Nutrition Needs and Addressing Food Insecurity During the COVID-19 Pandemic and Beyond” | Tuesday, June 29, 2021, at 2:00 PM ET
We will use this time to discuss innovative strategies to prevent and treat malnutrition among food insecure patients during the COVID-19 pandemic and your goals and ideas for continuing this work as the pandemic subsides.
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As a reminder, you can access member-only content, including webinar recordings and slides, on the MQii Member Portal. The login information is: Username: MQii Password: MQiiLC2018!
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Consider opportunities to share your MQii project and findings!
The following list 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. You may also view additional upcoming external events (such as conferences and webinars) on our new MQii Learning Collaborative Calendar.
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Also, here are two recent resources from other professional dietetics organizations that may useful:
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NUTRITION POLICY UPDATE
We are pleased to share that the Medical Nutrition Therapy Act of 2021 was introduced in both chambers of Congress last month. Both the House and Senate bills have received bipartisan support. This is the second time for these bills to be introduced. If passed, they would expand Medicare Part B coverage for MNT to encompass additional diagnoses—including malnutrition—as well as increase the types of providers who can refer patients for MNT. This action represents an important step for the dietetics profession and for advancing access to quality nutrition care for some of the most vulnerable patients. For more information, you can read this recent JAND article and review the Academy’s advocacy campaign Action Alert.
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MALNUTRITION RESEARCH
Several publications focused on malnutrition and quality improvement have been released over the past few months—some of which have been written by the MQii Leadership Team or Learning Collaborative members. These have been added to the Malnutrition Evidence Library on our website for your easy reference:
Also, the Agency for Healthcare Research and Quality (AHRQ) has published a draft report reflecting findings of its systematic review on malnutrition in hospitalized adults. The authors conclude that while evidence shows an association between malnutrition and increased mortality and prolonged length of stay among patients identified as malnourished, the strength of the association varies depending on patient population and assessment tool used. Therefore, they conclude further research is needed to assess the clinical utility of screening (including a control group) as well as the consistent use of a validated assessment tool. We encourage you to review the findings and consider submitting your comments on the methodology, findings, and utility by the 7/1 deadline.
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MALNUTRITION IN THE NEWS
The New York Times published a story earlier this spring about the expansion of federal nutrition programs during COVID-19 to address the growing burden of food insecurity and malnutrition among older Americans. In this article, titled “At Last, Aid for Senior Nutrition That Offers More Than Crumbs,” the author explains how flat funding for such programs has been insufficient to meet the growth in demand as well as size of the eligible senior population in recent years; however, the last four COVID-19 relief packages have included substantial increases in funding for the Older Americans Act (OAA) to provide more congregant meals (often provided as grab and go or through other innovative delivery programs during the pandemic) as well as deliveries through Meals on Wheels. As we know many of you are working to better meet nutrition needs for your patients after they are discharged, we encourage you to explore opportunities to access or use the OAA programs to connect your patients following discharge to community-based services. Such connections can help to enhance their food security, keep them better nourished, and prevent them from being readmitted.
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LEARNING COLLABORATIVE PARTICIPANT RESOURCES
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Call for Data: Submit Performance Data by July 31, 2021, to Be Part of the First 2021 MQii Performance Benchmark Report*
Did you know? Tier 1-level participants in the Learning Collaborative have the opportunity to contribute data on the malnutrition electronic clinical quality measures (eCQMs) and on patient outcomes to be benchmarked (anonymously) at the aggregate Learning Collaborative level. The performance benchmark report provides insights to each 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. 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. Additional indicators can provide insights regarding the provision of nutrition care to COVID-19 patients.**
Please email Angel Valladares if you would like to contribute 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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NFPE: Putting It All Together
One question that is frequently asked to the Academy’s NFPE Workshop Trainers is, “How often should the RDN perform an NFPE?” The trainers recommend:
- In the hospital setting: once a week, unless status change indicates sooner
- In the long-term care setting: at the time of regular nutrition assessment (i.e., monthly if care is needed or quarterly for stable residents); weekly for residents with acute or changing conditions
- In the outpatient setting: every appointment
- In dialysis centers: monthly with labs, unless status change indicates sooner
Performing NFPE on a regular basis allows the RDN to assess the changing nutritional status of the individual and provide appropriate interventions in a timely manner when such changes occur.
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