Clinical Malnutrition

Registered dietitian nutritionists have the opportunity and responsibility to be at the forefront of the prevention and treatment of malnutrition. The evidence-based tools and resources below, enable RDNs and NDTRs to screen and assess, diagnose and treat malnutrition across the healthcare continuum.

Malnutrition Quality Improvement Initiative

The Malnutrition Quality Improvement Initiative is a project of the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders who provided guidance and expertise through a collaborative partnership. The Academy of Nutrition and Dietetics and Abbott provides support for the MQii. The Academy collaborates with MQii partners and engages stakeholders to discuss malnutrition quality improvement and care transitions documented in Dialogue Proceedings. The MQii Toolkit provides practical, interdisciplinary tools and resources to help hospitals implement malnutrition best practices and adopt eCQMs to measure their success in meeting the standards of care.

Overview of Malnutrition Quality Measures
The resource provides descriptions of the eCQMs, Composite Measure and QCDR Malnutrition Quality Measures with the corresponding CMS quality incentive program identified.

Electronic Clinical Quality Measures
The Academy is a measure steward of four malnutrition electronic clinical quality measures. These four measures aim to promote appropriate screening, assessment, diagnosis and intervention with development of a care plan for malnourished adults in order to improve patient outcomes. Find out the what, who, when, why and how on eCQMs by reviewing the FAQs.

Global Malnutrition Composite Score
The nutrition quality measures for malnutrition screening, assessment, malnutrition diagnosis and development of a care plan have been combined into a composite measure to score hospitals on their efforts to identify malnutrition and improve care. The Global Malnutrition Composite Score measure would incentivize screening all older adults for malnutrition risk at hospital admission, assessing those found to be malnourished and at risk for malnutrition, documenting diagnosed malnutrition, and developing a nutrition care plan with implementing intervention and treatment before discharge which then follows patients as they transition to the next point of care setting. The Composite Measure, MUC20-0032 is included on the final published Centers for Medicare & Medicaid Services (CMS) 2020 Measures Under Consideration (MUC) List. The Academy continues to pursue the adoption of the Composite Measure into the CMS Hospital Inpatient Quality Reporting (HIQR) Program.

Malnutrition Quality Measures included in QCDRs
The Centers for Medicare & Medicaid Services has approved inclusion of new Malnutrition Quality Measures into two Qualified Clinical Data Registries (QCDRs) for RDNs to participate in the 2020 Merit-based Incentive Payment System (MIPS). The new Malnutrition Quality Measures included in the Premier Clinician Performance Registry and the U.S. Wound Registry promote health care team collaboration with measures for physician and RDN reporting. These measures are for MIPS reporting via QCDRs and do not replace the previous four (4) malnutrition eCQMs and the Global Malnutrition Composite Score measure (composite measure). For more information, listen to the QCDR Microlearning Series (1.0 CPEU) and review the FAQs.

Malnutrition Resources from the Academy of Nutrition and Dietetics

Academy of Nutrition and Dietetics Health Informatics Infrastructure
ANDHII provides the tools to track malnutrition in practice. Through the electronic nutrition care process and terminology, ANDHII can be used to track and report the incidence and prevalence of malnutrition alongside the impact of nutrition care on the clinical characteristics of malnutrition and patient outcomes.

Evidence Analysis Library
The Academy's Evidence Analysis Library published two systematic reviews in 2018. The Nutrition Screening Adults review examines the validity and reliability of adult nutrition screening tools. The cost of the malnutrition screening procedure was also reviews. The scope of the Nutrition Screening Pediatric review was to determine the validity and reliability of 14 pediatric nutrition screening tools to identify risk of malnutrition related to under- or over-nutrition and to determine if results varied according to users of the tools.

House of Delegates Dialogue Outcomes on Malnutrition
In 2015, the Academy's House of Delegates conducted a dialogue session to explore how RDNs can be leaders in the identification and management of malnutrition. Read the fact sheet with outcomes as a result of the meeting.

Journal of the Academy of Nutrition and Dietetics

The Journal publishes a multitude of malnutrition-related content, organized within the following collections:

Malnutrition Coding
This eatrightPRO page contains resources on hospital reimbursement for malnutrition and practice tools.

Nutrition Care Manual
The Adult, Pediatric, and Sports Nutrition Care Manuals are professional practice resources consisting of the largest client education library and current evidence-based nutrition recommendations for adults, children, and athletes. The Nutrition Care Manuals are updated annually and in 2019 the Adult Nutrition Care Manual included a brand new section with all-inclusive guidance for providing malnutrition care.

Nutrition Care Process and Terminology
The electronic Nutrition Care Process and Terminology provides up-to-date standardized language for documentation of malnutrition diagnoses, supporting evidence and nutrition interventions. The 2015 edition adds etiology-based malnutrition diagnosis terms to mirror the Academy and ASPEN consensus paper and all eNCPT malnutrition terms are mapped to SNOMED-CT for full compatibility with clinical information systems.

Nutrition Focused Physical Exam Hands-on Training Workshop
The Academy offers in-person training for registered dietitian nutritionists to accurately identify and nutrition diagnose adult or pediatric patients with, or at risk for, malnutrition. While a nutrition-focused physical exam is only one component of the nutrition assessment, it can provide necessary supportive data. Pocket guides for both pediatric and adult nutrition-focused physical exams are available in eatrightSTORE.

Malnutrition Resources from Other Organizations

Abbott Nutrition
The Abbott Nutrition Health Institute provides free RDN CPEU, including a certificate of training in adult malnutrition.

Alliance for Aging Research
The Alliance for Aging Research's website contains information on malnutrition in older adults including a short film, quiz and a health care professional tip sheet.

ASPEN Malnutrition Toolkit
Health care professionals can access malnutrition definitions, a nutrition care algorithm, screening and assessment tools, publications and more via ASPEN's Malnutrition Toolkit. Malnutrition-related online educational opportunities also are available.

Canadian Malnutrition Task Force
The Canadian Malnutrition Task Force provides malnutrition screening, diagnostic, treatment and monitoring resources on its website. Also available are guidelines, protocols, research posters and information on advocating for a culture of change in hospital foodservice

Defeat Malnutrition Today
A coalition including the Academy and many other organizations, Defeat Malnutrition Today emphasizes malnutrition screening and intervention. The website features infographics, articles, studies and the National Blueprint: Achieving Quality Malnutrition Care for Older Adults.

ENact Nutrition
Nestlé Health Science developed this web-based, integrated enteral nutrition program aimed at improving patient outcomes through the adoption of nutrition-focused quality improvement initiatives in the hospital setting.

Toolkit for Using the AHRQ Quality Indicators
The QI Toolkit is designed to support hospitals in assessing and improving the quality and safety of care they provide.