The Malnutrition Quality Improvement Initiative (MQii) is a multi-year effort that began in 2013 when a variety of stakeholder organizations began to highlight gaps in existing malnutrition care and the impact of these gaps on patient outcomes. Based on the results of subsequent literature reviews, landscape assessments, engagements with key stakeholders, and best practices research, the MQii was established in partnership with the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders providing guidance through key technical expert and advisory roles. The engagement was undertaken to advance evidence-based, high-quality patient-driven care for hospitalized older adults (age 65 and older) who are malnourished or at-risk for malnutrition. Support for the MQii was provided by Abbott.
To achieve the first of these objectives, the MQii developed and tested the new MQii Toolkit to advance the use of best practices for malnutrition care in a timely and effective manner. The Toolkit is evidence-based and is intended for use by all members of the care team (e.g., nurses, dietitians, physicians, and patients and caregivers) who engage in care for older adult patients who are malnourished or at risk of malnutrition. By using this Toolkit to support quality improvement (QI), hospitals may be able to:
The MQii Toolkit was tested over a three-month implementation period in 2016 through a multi-site Demonstration and Learning Collaborative. The Demonstration took pace at a single hospital that received hands-on training and support for the project, and collected extensive data to assess the impact of using the Toolkit. By contrast, a five-hospital Learning Collaborative implemented use of the Toolkit and tracked results with limited support, in order to understand how the Toolkit is adopted and used under real-world circumstances.
The Toolkit’s use demonstrated that the introduction of recommended malnutrition quality improvement actions helps hospitals achieve performance goals in nutrition care. Additionally, by helping hospitals achieve malnutrition standards of care, the resources provided through this initiative support adoption of malnutrition electronic clinical quality measures (eCQMs) by public and private accountability programs in the future to ensure the highest quality of malnutrition care across US hospitals.
The MQii Toolkit is provided here for your use to help you implement this initiative in your own hospital(s). Please explore the resources and information provided through the Toolkit in the following sections and see how this initiative can help advance malnutrition care where you work.
As noted above, you can use the MQii Toolkit to identify gaps in current malnutrition care practices and implement a QI project to achieve malnutrition standards of care. You may also choose to assess the impact of your quality improvement project – through a set of quality indicators (in the Toolkit) or a set of malnutrition electronic clinical quality measures (eCQMs).
To satisfy the second and third objectives of the project, the Academy of Nutrition and Dietetics and Avalere developed and tested a set of four malnutrition eCQMs throughout 2015-2016. The four eCQMs are:
These measures are currently under review by the Centers for Medicare & Medicaid Services (CMS) for proposed adoption into the Hospital Inpatient Quality Reporting Program, as well as the National Quality Forum (NQF) for consideration of endorsement.