eMeasure Title

Completion of a Nutrition Assessment for Patients Identified as At-Risk for Malnutrition within 24 hours of a Malnutrition Screening

eMeasure Identifier (Measure Authoring Tool) 517 eMeasure Version number 0.0.013
NQF Number 3088 GUID 75f51f87-ed16-41e7-89a9-d1034cb030fc
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
Patients identified as at-risk for malnutrition based on a malnutrition screening who have a nutrition assessment documented in the medical record within 24 hours of the most recent malnutrition screening.
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
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). 

In a study of 409 patients with a median age of 68, researchers were able to demonstrate that declining nutritional status as assessed by the subjective global assessment (SGA), a validated assessment tool, was significantly associated with prolonged length of stay (Allard, 2016).

A study of 733 from more than a dozen hospitals identified that the completion of a validated assessment for patients who were hospitalized was able to detect predictors of outcomes for malnutrition such as length of stay and readmission within 30 days after discharge. (Jeejeebhoy, 2015).
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) 
2. Nutrition assessment is suggested for all patients who are identified to be at nutrition risk by nutrition screening (Evidence Grade E) 

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.

A consensus statement from the Academy of Nutrition and Dietetics states that theregistered dietitian's (RD) assessment of critically ill adults should include, but not be limited to the following: Food and Nutrition-Related History, Anthropometric Measurements,  Biochemical Data, Medical Tests and Procedures, Nutrition-Focused Physical Findings, Client History. Assessment of the above factors is needed to correctly diagnose nutrition problems and plan nutrition interventions. Inability to achieve optimal nutrient intake may contribute to poor outcomes."
Improvement Notation
 
Reference
Kaiser MJ, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58(9):1734-8.
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
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
Sungurtekin H, Sungurtekin U, Oner O, Okke D. Nutrition assessment in critically ill patients. Nutr Clin Pract. 2008/2009;23:635-641.
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
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
Academy of Nutrition & Dietetics. CI: Nutrition Assessment of Critically Ill Adults 2012. Academy of Nutrition & Dietetics Evidence Analysis Library. Published  2012. Retrieved from: http://www.andeal.org/topic.cfm?menu=4800.
Reference
Allard JP, Keller H, Jeejeebhoy KN, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clin Nutr. 2016;35(1):144-52.
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
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.  
Definition
Guidance
 
Transmission Format
 
Initial Population
Patients age 65 years and older at time of admission who are admitted to an inpatient hospital
Denominator
Patients who were identified as at-risk for malnutrition upon completing a malnutrition screening
Denominator Exclusions
Patients with a length of stay of less than 24 hours
Numerator
Patients in the denominator who have a nutrition assessment documented in the medical record within 24 hours of the most recent malnutrition screening.
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