Implementation of malnutrition quality improvement reveals opportunities for better nutrition care delivery for hospitalized patients

Abstract

Background Gaps in hospital‐based nutrition care practices and opportunities to improve care of patients at risk of malnutrition or malnourished have been demonstrated by several US hospitals implementing quality improvement (QI) projects. This study examined the impact of nutrition care process improvements focused on better documentation of identification and diagnosis of malnutrition in 5 hospital services and differences between nutritionally targeted vs nontargeted services. Methods Data on malnutrition risk screening, nutrition assessment, malnutrition diagnosis, and nutrition care plan delivery were collected from 32,723 hospital encounters for patients admitted to the intensive care unit, pulmonology, oncology, urology, and general medicine services (targeted) as well as the rest of the nontargeted hospital services between 2017 and 2019. Results Higher rates of morbidity in targeted service patients compared with those in the patient population admitted in the nontargeted services were observed, including higher rates of malnutrition risk (37.43% vs 19.16%, P < .001), higher rates of moderate and severe malnutrition first identified by a registered dietitian nutritionist (20.27% vs 9.67%, P < .001), and malnutrition diagnosis confirmed by an admitting physician (16.72% vs 6.74%, P < .001). Conclusions The findings suggest sustained improvements in confirmed rates of malnutrition identification and diagnosis are achievable. Targeting malnutrition QI efforts to hospital services with higher patient morbidity is an effective method for improving malnutrition diagnosis, in particular in hospitals with limited resources, which in turn can result in improved nutrition care delivery.

The breath print represents a novel biomarker of malnutrition in pulmonary arterial hypertension: A proof of concept study

“…Early identification of malnutrition and the implementation of medical nutrition therapy has profound positive impacts on important clinical measures, including reductions in length of stay, readmissions, mortality, and hospital costs 2,3,46 . Significant advances have improved malnutrition assessment and diagnosis, 1,47–49 whereas the critical initial process, malnutrition screening, has remained largely stagnant and reliant on questionnaires 50–52 . This is due, in part, to the time constraints of the admissions process and the lack of effective blood biomarkers.…”