MQii Learning Collaborative 2 0 Transforming Quality and

MQii Learning Collaborative 2. 0: Transforming Quality and Performance Through Malnutrition Care Delivery

What is the MQii? The Malnutrition Quality Improvement Initiative (MQii) is a project of the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders who provided expert input through a collaborative partnership. This initiative aims to advance evidence-based, highquality, patient-driven care for hospitalized older adults who are malnourished or at-risk for malnutrition. 2

Overarching MQii Objectives Develop and disseminate a standardized MQii Toolkit for use by an interdisciplinary care team Advance the adoption of malnutrition electronic clinical quality measure (e. CQMs) Baseline Patient Conditions “that matter” & Various Fracture Types which make care for this population heterogeneous Expand availability of tools “Some patients are just too into sick, that can be integrated which leads to variability in care” electronic health record (EHR) systems ● To improve effectiveness of malnutrition care ● To help improve outcomes that are important to patients and clinicians ● To help improve care quality while minimizing administrative burden 3

MQii Provides the Tools to Achieve Care Goals The MQii Toolkit provides practical resources to enable hospitals to achieve optimal nutrition standards of care MQii Toolkit Implementation GOAL: Achieve Malnutrition Standards of Care MQii e. CQM Adoption Data reported from e. CQMs will help hospitals demonstrate if and by how much they are successful in meeting the standards of care QI: Quality Improvement 4

MQii Tools Support Care across the Care Continuum Malnutrition e. CQMs Align with the Malnutrition Care Workflow Screening Assessment Diagnosis Care Plan Intervention Monitoring/ Documentation Development Implementation Evaluation & of nutrition Establishment of Implementation of a Discharge Planning Nutrition screening using a validated tool for all patients 18+ with a hospital admission Nutrition assessment using a standardized tool for all patients 65+ identified as atrisk for malnutrition medical diagnosis for all patients 65+ identified as malnourished a nutrition care plan for all patients 65+ identified as malnourished or at-risk for malnutrition care plan including treatment for all patients identified as malnourished or atrisk for malnutrition** Implementation of processes, including discharge planning, that provide ongoing monitoring and support the care of patients identified as malnourished or at-risk for malnutrition** The MQii is rooted in patient-driven nutrition efforts that incorporate patient preferences and risk factors; four e. CQMs were developed to assist providers to monitor performance on the four steps in the workflow highlighted above **Measures for intervention implementation, monitoring/evaluation, and discharge planning were not technically feasible due to limitations in the availability of measure data. 5

Both Components of the Initiative are Grounded in Multi-Stakeholder Support Technical Expert Panel Advisory Committee Measure development informed by representatives from: • Atlanta Medical Center • Academy of Nutrition & Dietetics • National Health Council • EHRA Quality Measurement Workgroup • North Fulton Hospital • New York Presbyterian Hospital • Nutrition Informatics Computrition • University of Kansas Medical Center • Cleveland Clinic • Malnutrition Antagonists Toolkit design and implementation informed by representatives from: • Joint Commission • Academy of Nutrition and Dietetics • American Nurses Association • Patient organizations • Hospitals • Abbott Nutrition MQii e. CQM Development MQii Toolkit Development CMS Approach informed by regular communication with CMS to ensure alignment with CMS quality goals and adoption of best practices for a quality improvement demonstration 6