Background on Malnutrition, Food Insecurity, and Health Equity

Malnutrition places an immense burden on the healthcare system and poses significant risks to patient health outcomes, hospital performance, and broader community health. A major risk factor behind the clinical presentation of malnutrition is food insecurity, which is “a household-level economic and social condition of limited or uncertain access to adequate food.” Food insecurity may be influenced by a number of factors, including income, employment, race/ethnicity, and disability.

Despite substantial awareness of the burden of malnutrition, rates of diagnosis and identification of malnutrition are low, leaving many malnourished patients potentially undiagnosed and untreated. Malnutrition affects more than 30% of hospitalized patients, but only 9% of discharged patients had a coded malnutrition diagnosis in 2018. Patients require resources or assistance related to nutrition after discharge, but without adequate connections to community-based organizations and programs, patients’ needs may not be met—presenting a missed opportunity to improve their health. This phenomenon is magnified in underserved communities, contributing to even larger health disparities.

Roundtable Purpose

The Malnutrition Quality Improvement Initiative (MQii) aims to advance evidence-based, high-quality, patient-driven care for those who are malnourished or at risk of being malnourished. Figure 1 represents a recommended care pathway put forth by the MQii leadership team to jointly address nutrition and food insecurity risk. It accounts for the broad array of related risk factors that contribute to health disparities and how use of quality measurement can identify patients at risk and create accountability for implementing appropriate interventions to improve care.

To advance the work of the MQii and various organizations tackling these issues, a multi-stakeholder group of 23 leaders and experts in healthcare and community health came together for a roundtable entitled “Advancing Health Equity Through Malnutrition Quality Measurement” on March 3, 2022, to discuss connections between health equity, hospital malnutrition care, and food insecurity. Their directive was to identify and share solutions to these issues that can be readily implemented or replicated.

Roundtable Output

These identified solutions, and the understanding of existing barriers and challenges that the healthcare system already faces when treating malnutrition gathered from qualitative interviews with national experts prior to the Roundtable, brought the participants to discuss how solutions could be replicated and expanded. Participants focused on pathways to manage and address malnutrition, food insecurity, and health disparities across transitions of care while leveraging malnutrition composite measure performance data, hospital and community partnerships, and relevant experts all working toward the same goal. The conversation made it clear that these pathways and proposed solutions would require coordinated and collaborative efforts from all stakeholders. The results of this discussion are the basis for these proceedings, which outline a roadmap of actionable tactics for different stakeholder groups to advance malnutrition care and reduce food insecurity. Beginning with identification of malnutrition in the acute care setting and continuing through interventions implemented at the time of patients’ discharge and solutions integrated within the community, stakeholders can come together to advance health equity among underserved populations.

For more information, please direct any questions to Christina Badaracco or call 202-355-6094.

View the proceedings document and the executive summary.

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About the MQii

The MQii is a project of the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders who provide guidance and expertise through a collaborative partnership. The Academy of Nutrition and Dietetics provides resources and services to support the MQii. General support is provided by Abbott.