| eCQM Title | Global Malnutrition Composite Score |
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| eCQM Identifier (Measure Authoring Tool) | 986 | eCQM Version Number | 1.2.000 |
| NQF Number | Not Applicable | GUID | bff5e631-bcd1-4e4b-af54-9d93cd19c835 |
| 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 composite measure optimal malnutrition care focuses on adults 65 years and older admitted to inpatient service who received care appropriate to their level of malnutrition risk and/or malnutrition diagnosis if properly identified. Best practices for malnutrition care recommend adult inpatients to be screened for malnutrition risk, assessed to confirm findings of malnutrition if found at-risk, and have the proper severity of malnutrition indicated along with a corresponding nutrition care plan that addresses the respective severity of malnutrition. |
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| Copyright |
© Academy of Nutrition and Dietetics |
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| Disclaimer |
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| Measure Scoring | Proportion | ||
| Measure Type | Process | ||
| Stratification |
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| Risk Adjustment |
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| Rate Aggregation |
Each of the main components of this measure are strongly correlated with outcomes that have been empirically associated with malnutrition including 30-day readmissions and hospital length of stay. Each measure is correlated significantly to both malnutrition as a clinical outcome as well as the sequelae of untreated malnutrition including readmissions and longer length of stay. Therefore, the measure is constructed as an arithmetic average of the four components weighed equally. This is further supported by how the nutrition care process works in practice. Patient who are diagnosed and treated by a care team are most often first identified via a nutrition screening for malnutrition risk completed by a nurse around the time of admission prior to being referred to a registered dietitian for assessment and recommendations for malnutrition diagnosis and nutrition intervention. |
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| Rationale |
The process for risk identification, diagnosis, and treatment of malnutrition necessitates a multi-disciplinary care team that begins with identification of an initial risk population for more thorough physical assessment by registered dietitians (RDN). The RDN in turn provides the necessary treatment recommendations to address nutritional status and the clinical indicators that inform a medical diagnosis of malnutrition completed by a physician. The four component measures individually only provide a fraction of the necessary information on quality of care for patients at-risk of malnutrition. For example, knowing which patients have been assessed out of those who were initially identified as at-risk, but not knowing if the appropriate proportion of patients were screened upon admission would be an insufficient assessment of quality of care. |
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| Clinical Recommendation Statement |
The components of this composite measure are supported by clinical guidance that recommends the following: (1) malnutrition screening for patients admitted into the acute inpatient care setting; (2) nutrition assessment for patients at-risk of malnutrition in order to form the basis for an appropriate nutrition intervention; (3) appropriate recognition, diagnosis, and documentation of the nutrition status of a patient in order to address their condition with an appropriate plan of care and communicate patient needs to other care providers . Implementation of this measure has supported hospitals in the timeliness of the malnutrition risk screening process, the hand off of patients at-risk of malnutrition to Registered Dietitian Nutritionists (RDNs) in the hospital for appropriate nutritional assessment and development of nutrition care plans with recommended nutrition interventions, and the subsequent medical diagnosis and execution of the nutrition care plan with support from the patient’s physician. Evidence demonstrates that implementing a standardized protocol for screening, assessment, diagnosis and care planning results in better identification of malnourished patients and subsequent improvements in rates of nutrition intervention for the malnourished. Our outcomes modeling and those reported in other studies also demonstrates the benefits to patient outcomes, specifically reduced risk of 30-day readmissions. |
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| Improvement Notation |
Higher score indicates better quality of care. |
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| Reference | |||
| Definition |
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| Guidance |
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| Transmission Format |
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| Initial Population |
All adult inpatients age 65 years and older regardless of payer in need of malnutrition screening, nutrition assessment if found at-risk of malnutrition, or a malnutrition diagnosis and care plan if found malnourished by assessment. |
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| Denominator |
Patients age 65 years and older during the measurement period admitted into inpatient care with a length of stay less than or equal to 24 hours. |
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| Denominator Exclusions |
1. Patients with an admission to screening time interval greater than 48 hours from admission time 2. Patients discharged to hospice 3. Patients whose discharge status was indicated as left against medical advice (AMA) |
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| Numerator |
The aggregate malnutrition composite scores for all patients in the denominator which are scored based on four individual components of the composite including: 1. Screening for malnutrition risk at admission. 2. Completing a nutrition assessment for patients who screened for risk of malnutrition. 3. Appropriate documentation of malnutrition diagnosis in the patient’s medical record if indicated by the assessment findings. 4. Development of a nutrition care plan for malnourished patients including the recommended treatment plan. |
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| Numerator Exclusions |
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| Denominator Exceptions |
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| Supplemental Data Elements |
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"Valid Encounter" Encounter
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65
"Valid Encounter" Encounter
with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionScreen
such that MalnutritionScreen.authorDatetime 2 days or less before or on day of start of Encounter.relevantPeriod
None
"Valid Encounter" Encounter
with ["Assessment, Performed": "Malnutrition Risk Screening"] Screening
such that ( Screening.result as Code ~ "Nutritionally compromised (finding)" )
or ( Screening.result as Code ~ "At risk of nutritional deficit (finding)" )
or ( Screening.result as Code ~ "At risk for nutritional problem (finding)" )
None
None
None
"Valid Encounter" Encounter
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65
"Valid Encounter" Encounter
with ["Assessment, Performed": "Malnutrition Risk Screening"] Screening
such that ( Screening.result as Code ~ "Nutritionally compromised (finding)" )
or ( Screening.result as Code ~ "At risk of nutritional deficit (finding)" )
or ( Screening.result as Code ~ "At risk for nutritional problem (finding)" )
None
"Valid Encounter" Encounter
with ["Assessment, Performed": "Malnutrition Assessment"] Assessment
such that Assessment.authorDatetime during Encounter.relevantPeriod
None
None
None
"Valid Encounter" Encounter
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65
"Valid Encounter" Encounter
with "Nutrition Assessment Result" Result
such that Result.relevantDatetime during Encounter.relevantPeriod
"Valid Encounter" Discharge
where Discharge.dischargeDisposition in "Left Against Medical Advice"
or Discharge.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
"Valid Encounter" Encounter
with ["Diagnosis": "Malnutrition Diagnosis"] Diagnosis
such that Diagnosis.prevalencePeriod starts before
end of "Measurement Period"
None
None
None
"Valid Encounter" Encounter
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65
"Valid Encounter" Encounter
with ["Diagnosis": "Malnutrition Diagnosis"] Diagnosis
such that Diagnosis.prevalencePeriod starts before
end of "Measurement Period"
"Valid Encounter" Discharge
where Discharge.dischargeDisposition in "Left Against Medical Advice"
or Discharge.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
"Valid Encounter" ValidEncounter
with ["Intervention, Order": "Nutrition Care Plan"] CarePlan
such that CarePlan.authorDatetime during ValidEncounter.relevantPeriod
None
None
None
"Valid Encounter" Discharge
where Discharge.dischargeDisposition in "Left Against Medical Advice"
or Discharge.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"
"Valid Encounter" Encounter
with ["Assessment, Performed": "Malnutrition Risk Screening"] Screening
such that ( Screening.result as Code ~ "Nutritionally compromised (finding)" )
or ( Screening.result as Code ~ "At risk of nutritional deficit (finding)" )
or ( Screening.result as Code ~ "At risk for nutritional problem (finding)" )
"Valid Encounter" Encounter
with ["Diagnosis": "Malnutrition Diagnosis"] Diagnosis
such that Diagnosis.prevalencePeriod starts before
end of "Measurement Period"
"Valid Encounter" Encounter
with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionScreen
such that MalnutritionScreen.authorDatetime 2 days or less before or on day of start of Encounter.relevantPeriod
"Valid Encounter" Encounter
with ["Assessment, Performed": "Malnutrition Assessment"] Assessment
such that Assessment.authorDatetime during Encounter.relevantPeriod
"Valid Encounter" Encounter
with "Nutrition Assessment Result" Result
such that Result.relevantDatetime during Encounter.relevantPeriod
"Valid Encounter" ValidEncounter
with ["Intervention, Order": "Nutrition Care Plan"] CarePlan
such that CarePlan.authorDatetime during ValidEncounter.relevantPeriod
"Valid Encounter" Encounter
with ["Patient Characteristic Birthdate": "Birth date"] BirthDate
such that Global."CalendarAgeInYearsAt" ( BirthDate.birthDatetime, start of "Measurement Period" ) >= 65
["Assessment, Performed": "Malnutrition Assessment"] Assessment
where ( Assessment.result in "Nutritional Status Moderately Malnourished"
or Assessment.result in "Nutritional Status Severely Malnourished"
)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
/*Inpatient stay during the measurement period*/
["Encounter, Performed": "Encounter Inpatient"] Encounter
where Encounter.relevantPeriod during "Measurement Period"
and Encounter.lengthOfStay >= 24 hours
years between ToDate(BirthDateTime)and ToDate(AsOf)
DateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezoneoffset from Value)
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
| Measure Set |
1. Screening for malnutrition risk at admission. 2. Completing a nutrition assessment for patients who screened for risk of malnutrition. 3. Appropriate documentation of malnutrition diagnosis in the patient’s medical record if indicated by the assessment findings. 4. Development of a nutrition care plan for malnourished patients including the recommended treatment plan. |
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