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Malnutrition Care Score

The MCS assesses the percentage of hospitalizations for adults 65 years and older (if reporting data from 2024 and 2025) or all adults 18 years and older (for reporting data in 2026 or later), with a length of stay of at least 24 hours that have received optimal malnutrition care during the current inpatient hospitalizations.

The MCS follows evidence-based guidance to support malnutrition care.

Development of the MCS

In the United States, quality measures help patients choose high-performing clinicians and enable healthcare providers to assess and improve care. The Malnutrition Care Score (MCS) - formerly the Global Malnutrition Composite Score (GMCS)—is the first nutrition-focused electronic clinical quality measure (eCQM) included in the Centers for Medicare and Medicaid's (CMS) Hospital Inpatient Quality Reporting (IQR) Program under the FY 2023 Inpatient Prospective Payment System (IPPS) Final Rule.

Developed and stewarded by the Academy of Nutrition and Dietetics, the MCS was endorsed by the National Quality Forum (NQF) Consensus Standards Approval Committee (CSAC) for 2021-2024. In spring 2024, the Partnership for Quality Measurement (PQM) Endorsement and Maintenance (E&M) Committee also endorsed updated specifications that include the expansion to adults aged 18 and older (CBE ID 3592e).

References

Video

Malnutrition Identification and Documentation

Play Video

Malnutrition Identification and Documentation

Explore the role of RDNs in identifying and documenting malnutrition in adult patients, including the application of the AAIM and GLIM diagnostic frameworks; the assessment of etiology, phenotypic criteria and severity; and the importance of accurate PES documentation to support interdisciplinary care, treatment planning and quality improvement.

View transcript

Educational and Informational Resources

Discover education resources from the Academy and other sources, as well as find references and documents from government organizations and academic journals.

Malnutrition Quality Improvement Initiative

The Malnutrition Quality Improvement Initiative (MQII) is a project of the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders who collaborate to provide guidance and expertise for clinical malnutrition.

  • MQii Toolkit: Supports the implementation of malnutrition care best practices.
  • MQii Learning Collaborative: A community of clinicians committed to improving delivery of malnutrition care in hospitals and health systems across the U.S.

Reports

Infographics

CDR Enduring Activities

Peer-Reviewed Articles

Additional Resources

  • Avalere Health. (2022). Leveraging Inpatient Malnutrition Care to Address Health Disparities. Retrieved July 27, 2023.
  • Barrett ML, B. M. (2018). Non-maternal and Non-neonatal Inpatient Stays in the United States Involving Malnutrition, 2016. U.S. Agency for Healthcare Research and Quality. Retrieved July 27, 2023.
  • Mueller C, Compher C & Druyan ME and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. Nutrition Screening, Assessment, and Intervention in Adults. Journal of Parenteral and Enteral Nutrition. 2011; 35 (1): 16-24. A.S.P.E.N. Clinical Guidelines (wiley.com)
  • Arensberg MB, Saal-Ridpath K, Kerr K, Phillips W. Opportunities to Improve Quality Outcomes: Integrating Nutrition Care Into Medicare Advantage to Address Malnutrition and Support Social Determinants of Health. Inquiry. 2022 Jan-Dec; 59: 469580221081431. doi: 10.1177/00469580221081431. PMID: 35255728; PMCID: PMC8908402.
  • Bechtold ML, Nepple KG, McCauley SM, Badaracco C, Malone A. Interprofessional implementation of the Global Malnutrition Composite Score quality measure. Nutr Clin Pract. 2023 Oct;38(5):987-997. doi: 10.1002/ncp.11033. Epub 2023 Jul 11. PMID: 37431796.
  • Doley J, Phillips W. Accurate Coding Impacts the Geometric Length of Stay for Malnourished Inpatients. J Acad Nutr Diet. 2019 Feb;119(2):193-198. doi: 10.1016/j.jand.2017.10.023. Epub 2018 Feb 21. PMID: 29429855.
  • Guenter P, Abdelhadi R, Anthony P, Blackmer A, Malone A, Mirtallo JM, Phillips W, Resnick HE. Malnutrition diagnoses and associated outcomes in hospitalized patients: United States, 2018. Nutr Clin Pract. 2021 Oct;36(5):957-969. doi: 10.1002/ncp.10771. Epub 2021 Sep 6. PMID: 34486169.
  • Marshall S. Why Is the Skeleton Still in the Hospital Closet? A Look at the Complex Aetiology of Protein-Energy Malnutrition and Its Implications for the Nutrition Care Team. J Nutr Health Aging. 2018;22(1):26-29. doi: 10.1007/s12603-017-0900-9. PMID: 29300418.
  • Quartarolo J, Dolopo A, Richard B. Multidisciplinary effort to improve the diagnosis of malnutrition in hospitalized patients. Nutr Clin Pract. 2021 Oct;36(5):1068-1071. doi: 10.1002/ncp.10644. Epub 2021 Apr 5. PMID: 33821499.
  • Schuetz P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, Kutz A, Tribolet P, Bregenzer T, Braun N, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Henzen C, Mattmann S, Thomann R, Brand C, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet. 2019 Jun 8;393(10188):2312-2321. doi: 10.1016/S0140-6736(18)32776-4. Epub 2019 Apr 25. PMID: 31030981.
  • Shepherd E. Malnutrition coding and reimbursement in the hospital setting. Nutr Clin Pract. 2022 Feb;37(1):35-40. doi: 10.1002/ncp.10779. Epub 2021 Sep 29. PMID: 34587310. Skipper, A.; Coltman, A.; Tomesko, J.; Charney, P.; Porcari, J.; Piemonte, T.A.; Handu, D.; Cheng, F.W. Reprint of: Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults. J Acad Nut Diet. 2022; 122: S50-S54. doi: 10.1016/j.jand.2022.07.013.
  • Sriram K, Sulo S, VanDerBosch G, et al. Nutrition-Focused Quality Improvement Program Results in Significant Readmission and Length of Stay Reductions for Malnourished Surgical Patients. JPEN J Parenter Enteral Nutr. 2018;42(6):1093-1098. doi:10.1002/jpen.1040
  • White J V., Guenter P, Jensen G, Malone A, Schofield M. Consensus Statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition. 2012;36(3):275-283. doi:10.1177/0148607112440285
  • Wills‐Gallagher J, Kerr KW, Macintosh B, Valladares AF, Kilgore KM, Sulo S. Implementation of malnutrition quality improvement reveals opportunities for better nutrition care delivery for hospitalized patients. Journal of Parenteral and Enteral Nutrition. 2022;46(1):243-248. doi:10.1002/jpen.2086 27.
  • Sriram K, Sulo S, VanDerBosch G, et al. A comprehensive nutrition-focused quality improvement program reduces 30-day readmissions and length of stay in hospitalized patients. JPEN J Parenter Enteral Nutr. 2017;41(3):384-391.
  • Sulo S, Feldstein J, Partridge J, et al. Budget impact of a comprehensive nutrition-focused quality improvement program for malnourished hospitalized patients. Am Health Drug Benefits. 2017;10(5):262- 270.
  • Tappenden, KA; Quatrara, B; Parkhurts, M; Malone, A; Fanjiang, G; Ziegler, T. (2013). Critical Role of Nutrition in Improving Quality Care: An Interdisciplinary Call to Action to Address Adult Hospital Malnutrition. J Acad Nutr and Diet. 113 (9); 1219-1237.
  • Valladares AF, Kilgore KM, Partridge J, Sulo S, Kerr KW, McCauley S. How a Malnutrition Quality Improvement Initiative Furthers Malnutrition Measurement and Care: Results From a Hospital Learning Collaborative. JPEN J Parenter Enteral Nutr. 2021 Feb;45(2):366-371.

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