Assessment of the Nutrition Care Process in US Hospitals Using a Web-Based Tool Demonstrates the Need for Quality Improvement in Malnutrition Diagnosis and Discharge Care

Abstract

Background: Malnutrition in hospitalized patients is a pervasive problem in the United States. To our knowledge, although malnutrition has been acknowledged as a concern for >40 y, it has not yet been well addressed with a systematic, process improvement approach. Objectives: We aimed to characterize the current nutrition care process in US hospitals to establish a baseline for improvements. We also aimed to demonstrate the application of a web-based quality improvement tool as a simple approach to address malnutrition in hospitalized patients. Methods: We established a web-based tool to measure and assess nutrition care practices from hospital electronic medical records. Individual institutions self-selected to participate and were assigned a unique identifier to input data. Aggregated patient data from registered institutions were assessed. Data from all institutions were combined and are presented as the totals for each variable. Results: Of 243 registered users, 97 provided data and 150 reports were included in the analysis, resulting in a total of 107,106 patients. Almost all patients (89.98%) were screened for malnutrition risk within 24 h of admission, and ∼30% were at risk for malnutrition. Of those at risk, ∼65% received a registered dietitian nutritionist consultation or an order for an oral nutrition supplement. The rate of malnutrition diagnosis for those at risk was ∼14%, and <10% of patients received a recommendation or prescription for an oral nutrition supplement at discharge. Conclusions: Malnutrition remains an issue for hospitalized patients, particularly the gap between those screened as at risk and those diagnosed with malnutrition. Moreover, discharge recommendations for patients who are screened as at risk for malnutrition are also lacking. These data demonstrate that a web-based quality improvement tool could be used to capture the nutrition care practice at an institution level to provide directed approaches for addressing hospital malnutrition and improving care of patients at risk for malnutrition.

Improving Malnutrition in Hospitalized Older Adults: The Development, Optimization, and Use of a Supportive Toolkit

“…WHICH has been defined through an etiology-based approach and can include individuals who are underweight or overweight, 1 is a leading cause of morbidity and mortality, especially among older adults. 2,3 As many as half of all patients are malnourished or are at risk of becoming malnourished at the time of hospital admission, [4][5][6] with older adults especially at risk, often because of the health, physiologic, and functional changes associated with aging that can influence their nutritional status. 7,8 Early identification and treatment of these patients is the most effective way to reduce malnutrition-associated safety and health outcome issues.…”

“…In recent years, screening practices designed to detect patients at risk of malnutrition have become more widespread, and studies of their effectiveness have demonstrated that both patient health outcomes and hospital economic outcomes are improved when malnutrition is more effectively identified and treated. 6 Such malnutrition quality improvement (QI) efforts have ranged from taking basic steps for improving patient nutrition to implementing wide-sweeping overhauls of the entire process, including medical record reviews, tracking of nutrition supplement administration, and provision of enteral and parenteral nutrition support. 13-,15 In an effort to support hospitals seeking to implement malnutrition QI initiatives, the Malnutrition Quality Improvement Initiative (MQii) partners (Academy of Nutrition and Dietetics and Avalere Health) designed a toolkit (MQii Toolkit Team).…”

Proceso de Atención Nutricional: Elementos para su implementación y uso por los profesionales de la Nutrición y la Dietética

“…Aunque no forma parte del PAN, un requisito previo fundamental es realizar el cribaje nutricional para identificar a los P/C o grupos en riesgo que pueden beneficiarse de la valoración e intervención nutricional adicional 14,22,[35][36][37] .…”

Food intake assessment in acutely ill older internal medicine patients

“…The variety of triggers of malnutrition in older adults has led to the development of tools for its early screening . These tools are increasingly used to screen for malnutrition at hospital admission . Yet, studies show that malnutrition is not resolved during hospitalization; rather, it deteriorates for up to 20% of patients, at least in part because of poor food intake …”