eMeasure Title

Appropriate Documentation of a Malnutrition Diagnosis

eMeasure Identifier (Measure Authoring Tool) 518 eMeasure Version number 0.0.012
NQF Number 3090 GUID e6523a4f-361c-458f-81e7-58215ab12ec0
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward Academy of Nutrition and Dietetics
Measure Developer Academy of Nutrition and Dietetics
Endorsed By None
Description
Appropriate documentation of a malnutrition diagnosis for those patients who are found to be malnourished based on a nutrition assessment.
Copyright
"Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets.

CPT (R) contained in the Measure specifications is copyright 2015 by the Academy of Nutrition & Dietetics.

LOINC (R) copyright 2004-2014 [2.46] Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2013 [2013-09] International Health Terminology Standards Development Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]."
Disclaimer
"These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED ""AS IS"" WITHOUT WARRANTY OF ANY KIND."
Measure Scoring Proportion
Measure Type Process
Stratification
 
Risk Adjustment
 
Rate Aggregation
 
Rationale
"A retrospective analysis of pooled multinational data sets identified a prevalence of malnutrition in elderly patients in the hospital setting was 38.7% as identified by the validated malnutrition screening tool, the Mini Nutritional Assessment (MNA) (Kaiser et al., 2010).

Early Nutrition Intervention is linked to improved health outcomes, morbidity, mortality, and reduced pressure ulcers,  LOS and readmissions in the hospital. (Brugler, DiPrinzio & Bernstein, 1999), (Somanchi et al., 2011), (Kruizenga et al., 2003), (Kruizenga et al., 2005).

Patients who are malnourished while in the hospital have an increased risk of complications, readmissions, mortality rate and length of stay, which is also associated with a significant increase in costs. (Amaral, et al., 2007), (Corkins, 2011), (Correia & Waizberg, 2003), (Sungurtekin, Sungurtekin, Oner & Okke, 2008)

Nutrition supplementation in malnourished surgical patients has been shown to decrease the incidence of post-operative complications. (Brugler, DiPrinzio & Bernstein, 1999).

Feldman et al. (2009) identified that poor nutritional status has been known to have unfavorable effects. Individuals with less than 80% expected total body protein levels have demonstrated increased morbidity, and 10% or greater unintentional weight loss has been associated with adverse outcomes and prolonged hospitalizations. In lean healthy subjects, weight loss over 35%, protein loss over 30%, and fat loss over 70% from baseline has been associated with increased mortality.

In the absence of formal screening procedures, more than half the patients at risk of malnutrition are not identified and/or referred for treatment. Optimising the identification and treatment of malnutrition should improve patient outcomes such as faster wound healing, shorter hospital stays, lower pressure ulcer incidence, better quality of life, lower mortality. (Neelemaat et al., 2011)."
Clinical Recommendation Statement
"The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends the following:
3. Nutrition support intervention is recommended for patients identified by screening and assessment as at risk for malnutrition or malnourished.  (Grade Evidence C)

A consensus statement between the Academy of Nutrition and Dietetics and the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommends that assessment of malnourished patients or those at increased risk of malnutrition should be incorporated into the nutrition care process of the medical, nursing and/ pharmacy professions.

The Alliance to Advance Patient Nutrition recommends that a nutrition diagnosis be formally documented in a central area on the medical record or in the EHR as a part of a nutrition care plan."
Improvement Notation
 
Reference
Corkins MR, Guenter P, DiMaria-Ghalili RA & Resnick HE. Malnutrition diagnoses in hospitalized patients: United States, 2010. JPEN J Parenter Enteral Nutr. 2014;38(2):186-95.
Reference
Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazaré M, et al. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr. 2007 Dec;26(6):778–84. 
Reference
Correia MITD, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003 Jun;22(3):235–9.
Reference
Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001 Aug;17(7-8):573–80. 
Reference
Tappenden KA, Quatrara B & Parkhurst ML, et al. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Acad Nutr Diet.2013;113(9):1219-37. 
Reference
Somanchi et al., The Facilitated Early Enteral and Dietary Management Effectiveness Trial in Hospitalized Patients with Malnutrition. JPEN J Parenteral Enteral Nuutr 2011 35:209.
Reference
Kruizenga HM et al., Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. AM J Clin Nutrition 2005 Nov 82(5): 1082-9.
Reference
Cangelosi MJ, Rodday AM, Saunders T & Cohen JT. Evaluation of the economic burden of diseases associated with poor nutrition status. JPEN J Parenter Enteral Nutr. 2014;38(2 Suppl):35S-41S
Reference
Mueller C, Compher C & Druyan ME and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. Clinical Guidelines: Nutrition Screening, Assessment, and Intervention in Adults. J Parenter Enteral Nutr. 2011;35: 16-24.
Reference
The Academy of Nutrition and Dietetics. The Academy of Nutrition and Dietetics Nutrition Care Manual (NCM). Updated October 15, 2014. Retrieved from: https://www.nutritioncaremanual.org/
Reference
White JV, et al. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition).JPEN. 2012;36(3):275–283.
Reference
Alliance to Advance Patient Nutrition. Alliance Nutrition Care Model and Toolkit. Retrieved from: http://malnutrition.com/getinvolved/hospitalnutritiontoolkit.
Definition
Guidance
 
Transmission Format
 
Initial Population
Patients age 65 years and older admitted to inpatient care who have a completed nutrition assessment with findings of malnutrition documented in their medical record.
Denominator
Same as IP
Denominator Exclusions
Patients with a length of stay of less than 24 hours; 
Patients who left against medical advice (AMA);
Patients discharged to hospice care;
Numerator
Patients with a documented diagnosis of malnutrition.
Numerator Exclusions
 
Denominator Exceptions
 
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set