eMeasure Title

Nutrition Care Plan for Patients Identified as Malnourished after a Completed Nutrition Assessment

eMeasure Identifier (Measure Authoring Tool) 644 eMeasure Version number 0.0.010
NQF Number 3089 GUID 165e1b83-e4ad-449c-942e-c270353a0a66
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
A nutrition care plan 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
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. 

A randomized controlled trial of 652 hospitalized, malnourished older adults over the age of 65 evaluated the use of a high-protein oral nutrition supplement for its impact on patient outcomes of non-elective readmission and mortality. The study found no effects towards improving 90-day readmission rate compared to placebo, but saw a significant reduction of 90-day mortality (p = 0.018) (Deutz, 2016).

Nutrition support intervention in patients identified by screening and assessment as at risk for malnutrition or malnourished may improve clinical outcomes (Mueller, 2011). Several research studies associated early nutritional care after risk identification with improved outcomes such as reduced length of stay, reduction in risk of readmissions, and cost of care (Lew, 2016), (Meehan, 2016), (Milne, 2009), (Kruizenga, 2005).
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
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
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
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
Deutz NE, Matheson EM, Matarese LE, et al. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016;35(1):18-26.
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
Lew CC, Yandell R, Fraser RJ, Chua AP, Chong MF, Miller M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. JPEN J Parenter Enteral Nutr. 2016
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

      
Definition
Guidance
 
Transmission Format
 
Initial Population
Patients age 65 years and older admitted to inpatient care who have  a completed nutrition assessment documented in their medical record.
Denominator
Patients from the initial population with completed nutrition assessment documented in their medical record with findings of malnutrition.
Denominator Exclusions
Patients with a length of stay of less than 24 hours;
Numerator
Patients with a nutrition care plan documented in the patient's medical record. 

Care plan components include, but are not limited to: Completed assessment results; data and time stamp; treatment goals; prioritization based on treatment severity; prescribed treatment/intervention; identification of members of the Care Team, timeline for patient follow-up
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