Malnutrition Care: Preparing for the Next Level of Quality.

I N 2013, THE ACADEMY OF Nutrition and Dietetics (Academy) entered into a joint project with Avalere Health to improve quality of care in the US health system by recognizing the unaddressed area of malnutrition. Together the Academy and Avalere Health have embarked on a collaborative journey to advance high-quality, patient-driven care for hospitalized adults aged 65 years and older who are malnourished or at risk for malnutrition. Avalere Health is a research and advisory services firm that supports stakeholders in improving care delivery through better data, insights and strategies. Improving the care delivered to malnourished patients is a concern shared by many stakeholders. In November 2013 and September 2014, the Academy and Avalere Health conducted multi-stakeholder dialogues, where participants could discuss how to design and implement specific improvements tomalnutrition care inacute care settings. The dialogues included participants from the American Nurses Association, American Kidney Fund, Society of Hospital Medicine, Office of the National Coordinator for Health InformationTechnology, National Association of Nutrition and Aging Services Programs, Academy of Medical Surgical Nurses, Healthwise, American Society for Parenteral and Enteral Nutrition, The Joint Commission-Department of Quality Measurement, Discern Consulting, Centers for Medicare and Medicaid Services-Quality Improvement Group, Geisinger Health System-Regulatory Performance Improvement, University of Michigan Health Systems, AvaMedPayment and Health Care Delivery Policy,McKessonCorporation-Electronic Health Record Quality Measurement Workgroup, National Partnership for Women and Families, American Hospital Association-Quality & Patient Safety, Alliance to Advance Patient Nutrition, Abbott Nutrition, Avalere Health, and the Academy. The goal of the dialogues—‘reduced burden of hospital malnutrition by improving quality of nutrition care, defined by improved clinical outcome and reduced cost of care’—served as the springboard for participants to identify key levers for improved care, define how to achieve the desired results, and understand how results are measured. Participants defined subject areas to create a framework that would include key barriers to optimal care, identify areas prioritized for quality improvement and measurement, and summarize best practice domains and examples. The two dialogues resulted in three goals for malnutrition care of the older adult in the hospital setting: