Closing the Gap

By Peggi Guenter, PhD, RN, FAAN, FASPEN
ASPEN Senior Director of Clinical Practice, Quality, and Advocacy

Today, every 60 seconds, 10 hospitalized patients with malnutrition are not diagnosed – that’s 15,000 patients per day. This is compared to over a decade ago, when 14 hospitalized patients with malnutrition were not diagnosed per minute (21,000 patients per day).[1] We’re making progress and that is good news. But there more still needs to be done to close the gap.

Today is the first day of Malnutrition Awareness Week^TM.  As such, it’s an opportune time to focus on the clinical, patient, and policy priorities that can help make a difference in addressing the issue of malnutrition. Here are five steps to take action now to help ensure each patient receives the nutrition care they need:

1. It starts with awareness. In fact, ASPEN established Malnutrition Awareness Week^TM eight years ago with the express purpose of raising awareness: awareness among healthcare professionals to consider assessing and intervening earlier; and awareness for the public to realize that they need to ask about their nutrition status and advocate for optimal nutrition care as much as possible. This is important because malnutrition — which is a lack of, excess, or imbalance in protein, energy, or other nutrients — is common among hospitalized patients in the U.S. It is also associated with unfavorable outcomes including higher infection rates, poor wound healing, longer lengths of stay and higher frequency of readmission. Not unexpectedly, these outcomes are associated with increased healthcare costs and patient disability. ASPEN provides a range of practice-ready resources for clinicians to help tackle the issue of malnutrition.

2. We must also close the gap in education to improve clinical practice. The ASPEN Malnutrition Toolkit allows healthcare professionals to quickly access the latest articles, tools, educational opportunities, and websites to screen, assess, and diagnose malnutrition in clinical care settings.

3. Making malnutrition a priority for institutional quality improvement teams and implementing specific malnutrition care quality measures will help to drive improved health outcomes. Four malnutrition care electronic clinical quality measures have been developed and tested in acute care, focusing on malnutrition screening, assessment, and diagnosis, and development of a nutrition care plan. An on-line toolkit is available to help institutions implement these quality measures and thus improve malnutrition care and achieve better outcomes.

4. Empowering patients, families, and caregivers to recognize that: any patient can be at risk for malnutrition; and warning signs like unintended weight loss should be discussed with the healthcare team. ASPEN offers specific malnutrition tools and resources for patients and their caregivers and additional resources are available through the National Council on Aging.

5. Finally, to effectively close the gap, attention to malnutrition must be a priority for policymakers as well. The Defeat Malnutrition Today coalition led the development of a National Blueprint:  Achieving Quality Malnutrition Care for Older Adults, which outlines specific goals and strategies for multiple sectors, including national, state, and local governments and public and private payers. One specific recommendation is to “Recognize quality malnutrition care for older adults as a clinically relevant and cross-cutting priority in HHS’ Quality Measure Development Plan and the Surgeon General’s National Prevention Strategy.”

Malnutrition screening, assessment, diagnosis, and intervention can significantly contribute to the well-being of patients and should be part of their comprehensive medical care plans, from acute care to discharge and beyond. Working together, we can help close the gap in malnutrition diagnosis and support better health outcomes for the thousands of patients with malnutrition who currently leave the hospital every day undiagnosed.