Connecting the Dots for Quality Malnutrition Care

In an important development, starting in 2024, the Centers for Medicare & Medicaid Services (CMS) will include the Global Malnutrition Composite Score measure in its Inpatient Hospital Quality Reporting Program. This is the first nutrition-focused quality measure in any CMS payment program and is a boon for improved health equity and outcomes, as well as for older adults and community nutrition programs. Now it’s time to get busy and connect the dots for better malnutrition care.

  • Benefiting Health Equity
    The first of these dots to connect is health equity. CMS has said, “One factor contributing to the burden of malnutrition is health disparity across racial and ethnic groups.” The COVID-19 pandemic amplified and brought attention to the link between nutrition and food insecurity and health disparities, particularly for Black older adults. In a late 2021 Health Affairs blog post co-authored by Dr. Martha Dawson of the National Black Nurses Association we underscored how poor diet and lack of access to healthy foods are key contributors to those disparities. Further, the Global Malnutrition Composite Score measure can advance multiple health equity priorities that are part of the CMS Equity Plan for Improving Quality in Medicare.

    As health systems work to reduce health disparities and better address social determinants of health, implementing malnutrition quality improvement programs and the malnutrition quality measure will go a long way in supporting those efforts.
  • Benefiting Health Outcomes
    Dot number two to connect is health outcomes. A recent Agency for Healthcare Research and Quality systematic review found malnourished individuals experience more hospital-acquired complications and have higher mortality rates compared to well-nourished patients. According to a new report by the Congressional Research Service, malnutrition also is associated with other poor health outcomes, decreased function and quality of life, increased risk of falls and higher healthcare costs. Disease-associated malnutrition in older Americans is estimated to cost $51.3 billion annually. Yet, despite greater awareness of the burden of malnutrition, identification and diagnosis of malnutrition remain low, increasing risks for poorer health outcomes and increasing costs.

    Implementing malnutrition quality improvement programs and the malnutrition quality measure can help address malnutrition as a critical public health/patient safety issue and help reduce costs of care at a time when health systems face massive growth in expenses and rising inflation.
  • Benefiting Older Adults
    Older adults are living longer, but the dot to connect here is that they are not necessarily living healthier lives. Thus, even as older adults are one of the fastest growing segments of the population, they also have the greatest prevalence of chronic conditions. Of those ages 65 and older, 86% had at least one of six chronic conditions and the oldest old (ages 85 and older) were more frail, with more than 20% needing assistance with daily activities of living. It is not surprising then that up to one out of two older adults is either at risk of becoming or is malnourished and malnutrition is highest among those ages 85 and older. The risk of developing chronic conditions increases with age, yet research has shown that poor nutrition itself is a contributor.

    Improved nutrition supports healthy aging, reinforcing the need to implement malnutrition quality improvement programs and the malnutrition quality measure to help identify and intervene in cases of malnutrition.
  • Benefiting Community Nutrition Programs
    The last dot to connect is linking to community nutrition programs. Certainly, hospitals are the appropriate place to identify malnutrition during the patient admission process and then to address it. The Global Malnutrition Composite Score Measure reflects the key steps in the malnutrition care workflow: screening for malnutrition risk, conducting a nutrition assessment, documenting a malnutrition diagnosis, and developing a nutrition care plan. Hospitals then need to coordinate with community organizations, public agencies and outpatient nutrition services so patients can seamlessly continue with their nutrition interventions after discharge. As outlined in the National Blueprint: Achieving Quality Malnutrition Care for Older Adults, the Defeat Malnutrition Today coalition is committed to working to help support improved connections between hospitals and community-based nutrition programs to help ensure discharge nutrition care plans can be most effective.

    There are barriers to alleviating malnutrition as older adults transition across the continuum of care and implementing malnutrition quality improvement programs and the malnutrition quality measure can help address these barriers.

    The inclusion of the Global Malnutrition Composite Score measure in CMS’s inpatient hospital quality reporting program is a significant step forward for quality malnutrition care and is an opportunity for making meaningful connections that will advance health equity and improve health outcomes for older Americans.
    Robert Blancato, MPA, is the national coordinator of Defeat Malnutrition Today, a coalition of more than 120 stakeholders and organizations committed to defeating older adult malnutrition across the continuum of care through federal, state and local policy changes throughout the nation’s healthcare system.