Every year, older Americans are more than twice as likely to need hospitalization compared to middle age-adults. Alarmingly, many of these patients—20% to 50% are at risk of or are already experiencing malnutrition when admitted. During their hospital stay, up to 31% of malnourished patients and up to 38% of well-nourished patients may experience nutritional decline, with nearly a third eating less than a quarter of their hospital meals. Such unresolved malnutrition can contribute to hospital readmissions. Malnourished patients have a 54% higher likelihood of 30-day readmissions compared to well-nourished patients.
For all these reasons, nutrition plans to address malnutrition are an important part of successful hospital patient discharge. This post outlines opportunities for strengthening nutrition discharge plans following hospital stays and improving patient health outcomes.
Quality Hospital Malnutrition Care Includes Nutrition Discharge Plans
Effective post-discharge nutrition care is integral to a hospital's quality nutrition care process. It starts with routinely screening patients for malnutrition upon admission. Patients at malnutrition risk should then be assessed, diagnosed, and provided a comprehensive nutrition care plan that includes patient-centered goals and specific discharge recommendations. Additionally, it is essential that nutrition discharge plans are clearly communicated to the hospital’s discharge planners, the patient and caregivers, and then to primary care providers to ensure a smooth transition for patients moving from hospital to home or other care settings. Resource tools like the ASPEN discharge plan practice tool and the ASPEN Malnutrition Care Discharge Checklist can help.
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Nutrition Discharge Plan Elements
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Two new quality measures approved by the Centers for Medicare & Medicaid Services (CMS) support best practices for nutrition discharge planning. Implementing the Global Malnutrition Composite Score (GMCS) can help hospitals document and improve their nutrition care processes, including discharge recommendations as part of a nutrition care plan. The second is the Age Friendly Hospital Measure, which assesses the processes hospitals use to provide care for older adults. This measure requires hospitals to attest to having a process for malnutrition screening, implementing nutrition care plans, and including these plans on discharge instructions shared with post-discharge facilities.
Quality Improvement Programs Can Hone Nutrition Care Processes and Improve Nutrition Outcomes
Quality improvement programs (QIPs) are essential for refining the nutrition care process, including discharge planning. QIPs can lead to significant improvements in nutrition outcomes. For example, one quality improvement study conducted across 27 hospitals found that older adults with a malnutrition diagnosis and a nutrition care plan had a 24% lower likelihood of 30-day readmission, compared to those without a nutrition care plan. The Malnutrition Quality Improvement Initiative (MQii) toolkit includes additional ideas for discharged-focused nutrition QIPs.
Strong Community Nutrition Ties Are Essential
Connecting with local community nutrition service providers is crucial for supporting post-discharge nutrition care plans and can help hospitals identify patients’ needs using social determinants of health (SDOH) questions that may uncover food insecurity issues. Local service providers, such as Meals on Wheels and other home delivery meal services, may be covered under Medicare Advantage post-discharge meal programs. Scheduling follow-up appointments with outpatient RDNs and sending referrals directly to primary care physicians and post-acute care facility staff can also help improve patient follow-through and outcomes.
Patient-friendly Nutrition Discharge Instructions Help Support Success
Engaging patients, their families and caregivers is critical for an effective nutrition discharge process. Providing practical suggestions, such as encouraging a balanced diet, nutrient-dense snacks, and ONS if nutrition cannot be met through diet alone can help meet patient nutrition needs post-discharge. Discussing SNAP, HSA/FSA, and Medicare Advantage OTC coverage for ONS, and informing patients about pharmacy delivery options, can further aid patient access.
Nutrition discharge plans are essential for optimal nutrition care. Optimal nutrition care is associated with improved patient health outcomes and reduced hospital readmissions. By integrating comprehensive nutrition care plans, implementing quality measures, leveraging quality improvement programs, and establishing strong community connections, hospitals can ensure patients receive the necessary nutrition support during their recovery journeys.
Jillian Hyttenhove, MA, RD, CSOWM, LD, CHES, is the Medical Affairs and External Engagement liaison at Abbott Nutrition, a division of Abbott.
