The American Society on Aging’s strategic priority for Health and Well-being includes “exploring systems of care that address social determinants of health.” Nutrition is linked to multiple social determinants of health. Individuals diagnosed with moderate-to-severe malnutrition have poorer health outcomes and can incur up to 38% higher costs compared to their well-nourished counterparts. This is significant because malnutrition (or its risk) is found in 20%–30% of those in the community setting, but the rate can be higher than 70% in some older adult populations with certain chronic diseases or conditions.
One way to improve screening and intervention for malnutrition is by implementing a quality improvement program (QIP). QIPs consist of systematic and continuous actions that lead to measurable improvement in healthcare services and the health status of targeted patient groups. Hospitals and health systems are using QIPs to deploy and invite partners further upstream to focus on specific populations, social determinants and outcomes. Abbott recently collaborated with the University of Southern California (USC) to conduct a real-world QIP focused on evaluating the effectiveness of a nutrition care program in outpatient centers.
‘The nutrition-focused QIP required no additional visits or staffing resources to execute.’
The purpose of the 90-day nutrition-focused QIP was to improve care, reduce healthcare resource use, and lower costs. It was implemented across three USC outpatient centers and included 600 patients who were older than age 45. Physicians, physician assistants and registered dietitian nutritionists—all important healthcare providers (HCPs) who are part of USC’s outpatient clinic care team—implemented a new nutrition care process that included three simple steps:
- Screening and assessing all patients ages 45 and older for malnutrition or risk of malnutrition;
- Implementing a personalized nutrition care plan that included condition-specific oral nutrition supplements (ONS); and
- Providing nutrition education to patients and caregivers on the importance of nutrition and oral nutrition supplement compliance.
The USC HCPs were able to integrate the three steps of the nutrition-focused QIP within the patients’ routine visits, which meant the nutrition-focused QIP required no additional visits or staffing resources to execute. Further, under the QIP model, it takes just a few minutes to determine if someone is at nutritional risk, using tools like the malnutrition screening tool. Then a nutrition care plan can be created during that time, to ensure at-risk or malnourished individuals receive the appropriate care needed to support healing and recovery.
Reducing Costs and Improving Experience
This real-world study found that providing comprehensive nutrition care, including use of ONS, could help improve overall health and quality of life. This led to increased satisfaction and helped mitigate the risk of hospitalizations, resulting in overall cost savings.
Key results showed:
- More than 81% of patients were satisfied with the nutrition care they received;
- There was an 11.6% decrease in the percentage of individuals using healthcare resources over the 90-day study time period, helping HCPs to better manage their patients’ care while reducing costs; and
- Providing nutrition interventions led to a net savings of almost $500 per patient.
Nutrition-focused QIPs, like this study, demonstrate the effectiveness of providing comprehensive nutrition care. Prioritizing nutrition across different settings of care—including outpatient clinics—can help improve health outcomes and quality of care. It also supports HCPs in giving patients the greatest opportunity for a quick recovery and to return to living healthy, quality lives. In addition, the patient-focused approach benefits individuals and healthcare systems via cost savings and decreased economic burden.
The goal for QIPs is to be sustainable, scalable and reproducible at any health system or outpatient clinic, whether in a rural community or a large city, and still see positive outcomes. This nutrition-focused QIP builds on the work of the Malnutrition Quality Improvement Initiative (MQii) which is expanding beyond its initial work targeting the advancement of evidence-based, high-quality, patient-driven care for hospitalized older adults who are malnourished or at-risk for malnutrition. As health systems and providers face added pressures from rising health costs, value-based interventions—particularly those linked to social determinants of health—become increasingly important in acute and post-acute care.
Recently, the Centers for Medicare & Medicaid Services (CMS) finalized a new Improvement Activity (IA) addressing the screening/management of malnutrition and food insecurity as part of the 2022 Physician Fee Schedule Final Rule. Implementing nutrition-focused QIPs can help support this IA. QIPs provide real-world evidence of how effective strategies, policies and practices can help mitigate malnutrition and meet objectives of the healthcare triple aim: improving the experience of care, improving the health of populations, and reducing per capita costs of healthcare.
Cory Brunton, MS, BSN, RN, is a senior analyst of Global Health Economics, Outcomes Research and Policy, for the Abbott Nutrition Division of Abbott in Columbus, Ohio.