eMeasure Title

Completion of a Malnutrition Screening Within 24 hours of Admission

eMeasure Identifier (Measure Authoring Tool) 516 eMeasure Version number 0.0.014
NQF Number 3087 GUID dff69a7c-7959-45c4-a695-d323c28939b2
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
Completion of a malnutrition screening using a validated screening tool to determine if a patient is at-risk for malnutrition, within 24 hours of admission to the hospital
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].
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Measure Scoring Proportion
Measure Type Process
Stratification
 
Risk Adjustment
 
Rate Aggregation
 
Rationale
Patients who are malnourished while in the hospital have an increased risk of complications, readmissions, and length of stay, which is associated with a significant increase in costs. Malnutrition is also associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. (Corkins, 2014), (Barker et al., 2011), (Amaral, et al., 2007), (Kruizenga et al. 2005). Screening for the risk of malnutrition in care settings is important for enabling early and effective interventions. It is important that tools are validated to ensure that screening is as accurate and reliable as possible. (NICE, 2012)

In addition to being a condition with an underestimated prevalence, the literature indicates that there is also a significant economic burden to society associated with malnutrition. Using data from the National Health Interview Survey and the National Health and Nutrition Examination Survey (NHANES), Snider (2016) estimated that the annual burden of disease-associated malnutrition across 8 major diseases with high morbidity was $156.7 billion.
Clinical Recommendation Statement
The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends the following:
1. Screening for nutrition risk is suggested for hospitalized patients (Evidence Grade E) 

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommend nutritional screening, which is rapid and simple, to be used to determine patients who are nutritionally at risk.

The National Institute for Health and Care Excellence (NICE) recommends that people in care settings are screened for the risk of malnutrition using a validated screening tool. In addition, they recommend that screening should be carried out when there is clinical concern, for example, if the person has unintentional weight loss, fragile skin, poor wound healing, apathy, wasted muscles, poor appetite, altered taste sensation, impaired swallowing, altered bowel habit, loose-fitting clothes or prolonged intercurrent illness.

According to The Joint Commission manual PC-010203,EP-7, the hospital completes a nutrition screening when warranted by the patient’s needs or conditions within 24 hours after inpatient admission.

The British Association for Parenteral and Enteral Nutrition recommends the maintenance of documentation for all individuals including results of nutritional screening and assessments, along with consequent action plans and treatment goals. If the patient is transferred to another care setting, this information should be readily available to all new carers to ensure continuity of care.
Improvement Notation
 
Reference
Barker et al., Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System.  J Environ Res Public Health. Feb 2011; 8(2): 514–527. Published online Feb 16, 2011.  
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
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
Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MAE. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr. 2005 Nov;82(5):1082–9.
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
J. Kondrup, S. P. Allison, M. Elia, B. Vellas, and M. Plauth, “ESPEN guidelines for nutrition screening 2002,” Clinical Nutrition, vol. 22, no. 4, pp. 415–421, 2003.
Reference
National Institute for Health and Care Excellence. NICE Quality Standard [Q24] Nutrition Support in Adults. Retrieved from: https://www.nice.org.uk/guidance/qs24/chapter/quality-statement-1-screening-for-the-risk-of-malnutrition; Published November 2012.
Reference
British Association for Parenteral and Enteral Nutrition. Malnutrition Matters, A Toolkit for Clinical Commissioning Groups and providers in England. Published 2012. Retrieved from: http://www.bapen.org.uk/pdfs/bapen_pubs/bapen-toolkit-for-commissioners-and-providers.pdf. 
Reference
Snider JT, Linthicum MT, Wu Y, et al. Economic burden of community-based disease-associated malnutrition in the United States. JPEN J Parenter Enteral Nutr. 2014;38(2 Suppl):77S-85S.
Definition
Guidance
 
Transmission Format
 
Initial Population
All patients age 18 years and older at time of admission who are admitted to an inpatient hospital
Denominator
All patients age 18 years and older at time of admission who are admitted to an inpatient hospital
Denominator Exclusions
Patients with a length of stay of less than 24 hours;
Numerator
Patients in the denominator who have a completed malnutrition screening documented in the medical record within 24 hours of admission to the hospital. For the purposes of this measure, it is recommended that a malnutrition screening be performed using a validated screening tool which may include but is not limited to one of the following validated tools:

Malnutrition Screening Tool (MST) (Wu, 2012), Nutrition Risk Classification (NRC) (Kovacevich, 1997), Nutritional Risk Index (NRI) (Honda, 2016), Nutritional Risk Screening 2002 (NRS-2002) (Bauer, 2005), Short Nutrition Assessment Questionnaire (SNAQ) (Pilgrim, 2016).

Bauer JM, Vogl T, Wicklein S, Trögner J, Mühlberg W, Sieber CC. Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z Gerontol Geriatr. 2005;38(5):322-7.

Kovacevich DS, Boney AR, Braunschweig CL, Perez A, Stevens M. Nutrition risk classification: a reproducible and valid tool for nurses. Nutr Clin Pract. 1997;12(1):20-5.

Honda Y, Nagai T, Iwakami N, et al. Usefulness of Geriatric Nutritional Risk Index for Assessing Nutritional Status and Its Prognostic Impact in Patients Aged =65 Years With Acute Heart Failure. Am J Cardiol. 2016;

Pilgrim AL, Baylis D, Jameson KA, et al. Measuring Appetite with the Simplified Nutritional Appetite Questionnaire Identifies Hospitalised Older People at Risk of Worse Health Outcomes. J Nutr Health Aging. 2016;20(1):3-7.

Wu ML, Courtney MD, Shortridge-baggett LM, Finlayson K, Isenring EA. Validity of the malnutrition screening tool for older adults at high risk of hospital readmission. J Gerontol Nurs. 2012;38(6):38-45.
Numerator Exclusions
N/A
Denominator Exceptions
N/A
Supplemental Data Elements
Patient Characteristic Sex: ONC Administrative Sex
Patient Characteristic Race: Race
Patient Characteristic Ethnicity: Ethnicity
Patient Characteristic Payer: Payer

Table of Contents


Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set