New Malnutrition Quality Measures Will Lead to Higher Quality, Lower-Cost Care

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New quality measures to address malnutrition among hospitalized older adults are now being evaluated by the National Quality Forum (NQF) for endorsement, and by the Centers for Medicare & Medicaid Services (CMS) for inclusion in their Hospital Inpatient Quality Reporting Program.
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Malnutrition is an under-recognized and growing health crisis in our nation for older adults. Up to 60 percent of patients are malnourished upon admission to the hospital; yet only 7 percent are diagnosed with this condition. This gap is due to challenges including lack of provider visibility into patients’ nutritional status and how malnutrition information is communicated and tracked in hospital medical record systems. As a result, many patients fail to receive the malnutrition care that they need. Furthermore, malnutrition costs associated with older adults are estimated to have an annual economic burden of $51.3 billion in the U.S.

To address this critical public health issue, Avalere Health partnered with the Academy of Nutrition and Dietetics to create the Malnutrition Quality Improvement Initiative (MQii). They, in collaboration with multi-disciplinary technical experts and advisors, have developed the first malnutrition electronic clinical quality measures (eCQMs) and an online Toolkit to help hospitals implement malnutrition standards and best practices for older adults. Available today, the four eCQMs and the Toolkit will help clinicians detect and treat malnutrition using a standardized approach for screening, assessment, diagnosis, intervention and monitoring.

“Malnutrition affects an alarming number of older adult patients in the hospital setting, where treatment can and should be readily available. Failure to treat malnutrition leads to worse health outcomes, higher costs, higher readmissions,” said Kristi Mitchell, senior vice president at Avalere. “Using a standardized set of quality measures to integrate screening, assessment, and diagnosis for malnutrition into routine hospital care has the potential to not only save lives, but to reduce overall healthcare costs”.

The MQii’s approach is in response to studies that have shown malnourished patients, particularly older adults, experience longer hospital stays, higher rates of readmissions, greater incidence of infection and complications, and higher overall costs compared to well-nourished patients. Further, early and consistent identification and treatment of malnutrition has been demonstrated to improve patient outcomes and lower medical costs. The malnutrition eCQMs are first of their kind; no other quality improvement effort before has focused on this aspect of care. These efforts represent a chance to significantly impact patients and bring much-needed attention to malnutrition.

The MQii Toolkit provides practical, interdisciplinary tools and resources to help hospitals implement malnutrition best practices while data reported from the eCQMs helps hospitals to measure their success in meeting the standards of care. If health care facilities adopt the eCQMs into their electronic health record systems, they will help ensure that patients at risk for malnutrition are identified and nutrition treatment for those patients is coordinated across all members of the care team. Together, these tools are positioned to uniquely support hospitals to advance the critically important quality of malnutrition care for their patients and improve related outcomes and performance measures.

Alison Steiber, chief science officer at the Academy of Nutrition and Dietetics, said “The eCQMs and the Toolkit are important in implementing these measures. They provide great resources for health care providers to begin tackling malnutrition in their hospitals.”

“This is a great start,” said Bob Blancato, national coordinator for Defeat Malnutrition Today. “We are excited to host the MQii Toolkit on our website. Malnutrition poses a real threat to our older adult population and we are committed to advancing policies and quality care for malnourished and at-risk seniors across acute, post-acute and community settings.” Defeat Malnutrition Today is a coalition of more than 40 organizations who share the goals of achieving the recognition of malnutrition as a key indicator and vital sign of adult health.

What’s Next: Advancing Adoption of Malnutrition eCQMs and Toolkit

The four malnutrition eCQMs have been developed and submitted to CMS for review and adoption into the Hospital Inpatient Quality Reporting Program, a pay-for-reporting program with more than 4,000 participating hospitals reporting. If approved, the measures would be the first malnutrition electronic clinical quality measures added to the federal reporting program and would elevate the practice for registered dietitian nutritionists.

The eCQMs have also been submitted to the NQF for endorsement. The NQF endorsement process is designed to produce consensus from a broad spectrum of groups, each representing a different part of the health care system, around the use of performance measures to report on the quality and efficiency of health care in the U.S.

Sharon McCauley, senior director of quality management at the Academy of Nutrition and Dietetics said: “Through this initiative, we have been able to establish essential quality measures that could help improve patient outcomes and have a long-lasting effect on registered dietitian nutritionists’ clinical care delivery to hospitalized adult patients. We appreciate the guidance from the National Quality Forum and the support of our health partners in considering these care standards to address gaps in malnutrition quality of care.”

By using the MQii eCQMs and Toolkit, hospitals and care teams will have the information and resources necessary to advance evidence-based, high quality and patient-driven care for hospitalized older adults who are malnourished or at risk for malnutrition, thereby improving outcomes and lowering costs. The MQii eCQMs and the Toolkit are available for use today by clinicians and hospitals and can be accessed at and at www.MQii.Today respectively. For more information on malnutrition and the MQii go to Avalere Insights to listen to malnutrition podcasts.

Support for the Malnutrition Quality Improvement Initiative was provided by Abbott.


1. Data on annual economic costs of malnutrition is from Snider et al., “Economic burden of community-based disease-associated malnutrition in the United States.”

Avalere Health is a strategic advisory company whose core purpose is to create innovative solutions to complex healthcare problems. Based in Washington, DC, the firm delivers actionable insights, business intelligence tools and custom analytics for leaders in healthcare business and policy. Avalere’s experts span 230 staff drawn from Fortune 500 healthcare companies, the federal government (e.g., CMS, OMB, CBO and the Congress), top consultancies and nonprofits. The firm offers deep substance on the full range of healthcare business issues affecting the Fortune 500 healthcare companies. Avalere’s focus on strategy is supported by a rigorous, in-house analytic research group that uses public and private data to generate quantitative insight. Through events, publications and interactive programs, Avalere insights are accessible to a broad range of customers. For more information, visit, or follow us on Twitter @avalerehealth.

The Academy of Nutrition and Dietetics is the world’s largest organization of food and nutrition professionals. The Academy is committed to improving the nation’s health and advancing the profession of dietetics through research, education and advocacy. Visit the Academy of Nutrition and Dietetics at

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