MQii Toolkit Overview Presentation

1. MQii Toolkit Overview Presentation

2. Presentation Roadmap • Overview of the MQii • Key Aspects of MQii Toolkit Implementation • Next Steps 1 2 3

3. Overview of the MQii

4. Malnutrition is a Burden That Significantly Impacts Patient Outcomes MALNUTRITION IS ASSOCIATED WITH A HIGH BURDEN OF DISEASE, INCREASED COMORBIDITIES, AND SIGNIFICANT ECONOMIC COSTS Up to 65 percent of older adults admitted to hospital may be malnourish3 1 in 3 patients are malnourished upon hospital admission1,2 Malnutrition increases length of stay by 4 to 6 days4 Malnutrition increases costs by up to 300 percent5 Coats KG et al. Hospital-associated malnutrition (a reevaluation 12 years later). J Am Diet Assoc. 1993; 93:27–33. 1. Coats KG et al. Hospital-associated malnutrition (a reevaluation 12 years later). J Am Diet Assoc. 1993; 93:27–33. 2. Giner M et al. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition 1996; 12:23-29. 3. Aging Network Staff. Malnutrition and Older American. National Resource Center on Nutrition, Physical Activity & Aging. Available at: http://nutritionandaging.fiu.edu/aging_network/malfact2.asp. Accessed February 3, 2015. 4. Barker et al., Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System. J Environ Res Public Health. Feb 2011; 8(2): 514–527. 5. Isabel TD and Correia M. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical Nutrition. 2003;22(3):235–239.

5. Malnutrition is Often Under-Diagnosed • 36 million U.S. hospitalizations per year1 • 15% – 60% are malnourished2 • 7% are diagnosed with malnutrition2 • 4 million – 19 million cases left undiagnosed and therefore untreated 1. HCUP Databases. Healthcare Cost and Utilization Project (HCUP). November 2014. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 1/14/2015. 2. White, J. V., Guenter, P., Jensen, G., Malone, A., & Schofield, M. (2012). Consensus statement of the academy of nutrition and dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). Journal of the Academy of Nutrition and Dietetics, 112(5), 730-738. 3. Weiss AJ, Fingar KR, Barrett ML, Elixhauser A, Steiner CA, Guenter P, Brown MH. Characteristics of Hospital Stays Involving Malnutrition, 2013. HCUP Statistical Brief #210. September 2016. Agency for Healthcare Research and Quality, Rockville, MD.  http://www.hcup-us.ahrq.gov/reports/statbriefs/sb210-Malnutrition-Hospital-Stays-2013.pdf. = 1 million hospitalizations

6. The Malnutrition Quality Improvement Initiative Aims to Address Gaps and Barriers to Quality Care Identify existing gaps in evidence and measurement Conduct malnutrition best practices research in acute care settings Launch “Malnutrition Quality Improvement Initiative” (MQii) Engage with key stakeholders (e.g., CMS) to discuss care barriers Hold two national dialogues to identify opportunities for optimal malnutrition care High quality nutrition care has been shown to decrease complications by 14% and avoidable readmissions by 28% Quickly identifying at-risk patients who can benefit from nutrition intervention can improve patient outcomes and costs

7. Toolkit Implementation Intends to Enhance the Quality of Malnutrition Care across the Care Continuum Malnutrition Care Workflow • Screening • Nutrition screening using a validated tool for all patients with a hospital admission • Assessment • Nutrition assessment using a standardized tool for all patients identified as at-risk for malnutrition • Diagnosis • Documentation of nutrition diagnosis for all patients identified as malnourished Care Plan Development Establishment of a nutrition care plan for all patients identified as malnourished or at-risk for malnutrition Intervention Implementation Implementation of a nutrition care plan including treatment for all patients identified as malnourished or at-risk for malnutrition Monitoring/ Evaluation & Discharge Planning 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

8. Key Aspects of MQii Toolkit Implementation

9. Multidisciplinary Project and Care Teams Are Essential for Effective Implementation of the MQii • The Project Team consists of demonstration leaders responsible for guiding overall execution of the intervention • The Care Team is responsible for direct patient care • Given the consideration of patient-driven care throughout this demonstration, patients/family caregivers are considered an integral part of the Care Team Hospital Staff Non-Hospital Staff

10. Care Team Involvement Will Be Critical for Achieving a Successful Quality Improvement Intervention Quality improvement rests on systematic, organized activities that are implemented to monitor, assess, and improve healthcare delivery

11. The MQii Is Centered Upon a Toolkit for Use by All Care Team Members to Improve Malnutrition Care QI: Quality Improvement The Toolkit is a guide for identifying and implementing QI interventions for malnutrition care • Its components have been well-validated and, in many cases, reflect best practices being used in some hospital sites • The MQii offers the opportunity to assess varied and inconsistent implementation of care practices and disseminate improved practices to a variety of team members • The Toolkit provides: • A clear workflow and description of care processes for optimal malnutrition care • Associated tools and relevant resourcesthat support quality improvement processes • Suggested best practices for screening, assessing, and treating older adults admitted to hospital with or at risk of malnutrition

12. MQii Toolkit Implementation Will Allow Assessment of Four Primary Research Objectives Toolkit Implementation Objectives 1 2 3 4

13. Care Team Leadership Is Critical for Obtaining MQii Demonstration Results & Inform Research Objectives • Objective #1: Reduce clinical practice variability Your Role • Support changes and enhancement to clinical care practices • Support use of recommended clinical workflow for optimal nutrition care by ensuring timely and consistent care of malnutrition care best practices • Serve as leaders in change management and help care team members meet initiative goals and data collection requirements • Be familiar with eMeasures or quality indicators used and help monitor how care team members track this information • Ensure that conducted workflow mapping is an accurate reflection of actual current practices • Confirm target areas for clinical improvement and methods for implementation * Also a Learning Collaborative research question

14. Care Team Leadership Is Critical for Obtaining MQii Demonstration Results & Inform Research Objectives • Objective #2:Provide a feasible and usable malnutrition quality improvement Toolkit Your Role • Support implementation and assessment of the Toolkit • Be familiar with toolkit strategies help ensure implementation of recommended care workflow • Provide your feedback on implementation of this toolkit or initiative by sharing thoughts on ease of use and relevance for changing care practices • Participate in regular team meetings and share information on barriers or challenges and successes of implementation * Also a Learning Collaborative research question

15. Care Team Leadership Is Critical for Obtaining MQii Demonstration Results & Inform Research Objectives • Objective #3:Improve levels of malnutrition Your Role • Understand importance and impact of malnutrition on patient outcomes and associated costs • Help educate other care teams of this importance and strategies for improving malnutrition care • Work with PI to facilitate administration of knowledge attainment test pre- and post- demonstration (if applicable) • Complete knowledge attainment test pre- and post- demonstration (if applicable) * Also a Learning Collaborative research question

16. Care Team Leadership Is Critical for Obtaining MQii Demonstration Results & Inform Research Objectives Objective #4:Explore clinical outcomes of average length of stay and 30-day all-cause readmission rates Your Role • Help oversee care team documentation of accurate clinical care practices • Help reduce these rates by improving quality of malnutrition care as recommended by toolkit strategies * Also a Learning Collaborative research question

17. Changes in Care Practices Can Be Monitored Using Suggested MQiieMeasures* and/or Quality Indicators Data collected for the MQiieMeasures and quality indicators will serve to inform: Whether or not the recommended clinical workflow and timing of care is being met through implementation of clinical improvements Areas to target for quality improvement to best meet recommended clinical practices Collection of data on these measures and indicators is voluntary but strongly encouraged. The goal is to assess care practices of healthcare providers; no patient data or PHI needs to be collected • Your Project Team Manager will work with your Informatics Representative to determine which of the eMeasures and/or quality indicators can currently be collected through your facility’s EHR • For those not currently captured, assess whether it may be feasible to create additional data fields to capture this information during your implementation phase • If unable to capture electronically, discuss how to collect any data manually *eMeasures are electronic clinical quality measures that use data from the electronic health record to calculate the measures. A complete list of suggested MQii eMeasures and quality indicators is provided in “Plan for Data Collection” section of the MQii Toolkit.

18. Responsibilities of Participating Sites Include Supporting MQii Implementation and Evaluation

19. MQii Preparation and Implementation Typically Occurs Over a 6-Month Period Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Kickoff and Training Engage & Finalize MQii Staff Participants Administer Knowledge Attainment Post-test (Optional) Administer Knowledge Attainment Pre-test (Optional) Implementation Timeline 3-month Implementation Period Data Collection, Analysis, and Feedback Pre-Demonstration Demonstration Post-Demonstration

20. Next Steps

21. Next Steps Review the MQii training presentation available on the MQii website to support implementation of your clinical improvements. You may also want to take the MQii Readiness Questionnaire to determine your facility’s ability to implement this initiative. Review the quality improvement objectives outlined in the MQii Toolkit and conduct suggested workflow mapping of existing processes to determine alignment/misalignment with recommended workflow Based on workflow mapping, identify opportunities for improvement within your existing processes. Use the Malnutrition Care Assessment and Decision Tool if you need more guidance Provide training to Care Team members on the Toolkit, focusing specifically on the selected clinical improvements and recommended clinical workflow