GLOBAL MALNUTRITION COMPOSITE SCORE

The Centers for Medicare and Medicaid Services (CMS) is an insurer, but also collects and analyzes data to produce reports utilizing quality improvement and quality measurement data to improve outcomes while reducing burden on clinicians and providers.

Within the CMS programs lies the Inpatient Quality Reporting (IQR) Program, a pay-for-reporting initiative that requires hospitals to submit quality and safety data to reduce complications, lower mortality rates, and deliver high-quality care. These results are publicly shared on the Care Compare website. 

Electronic clinical quality measures (eCQMs), part of the IQR Program, leverage data extracted from electronic health records (EHR) or health information technology (HIT) systems to assess care quality. Hospitals submit eCQM data directly from these systems. 

For Reporting Period 2024 and 2025, Eligible Hospitals and Critical Access Hospitals must report on 6 electronic clinical quality measures for each reporting period-three mandatory and three self-selected. The GMCS was approved as a self-selected eCQM and is 1 of 9 eCQMs available for reporting periods 2024 and 2025. 

When implementing the GMCS, understanding key reporting terms is crucial. The Reporting Period is the calendar year that the data will be collected. The data collected will then be submitted the following year, during the Submission Period. 

Ultimately, the data reported and submitted will directly be linked to the Payment Period Fiscal year that corresponds to the year after the Submission Period.

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The GMCS assesses the percentage of hospitalizations for adults 65 years and older (if reporting data from 2024 and 2025) or all adults 18 year of age (for reporting data in 2026 or later), with a length of stay of at least 24 hours that have received optimal malnutrition care during the current inpatient hospitalizations.

The GMCS follows evidence-based guidance to support malnutrition care, as shown below.

For measure specifications and implementation tools click here.

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Malnutrition is defined as the inadequate intake of nutrients or energy, over time, and can have many root causes. A hospitalized patient with malnutrition can place a strain on resources, and negatively affect quality outcomes, as shown in the figure below.

Clinical guidelines for addressing malnutrition in acute care settings establish that a patient should first be screened for risk for malnutrition, those at risk should be further assessed, and if found to have malnutrition by assessment, then a nutrition support plan should be established (3). 

Effective malnutrition care processes benefit from interdisciplinary collaboration. This type of care offers an opportunity to develop a comprehensive and individualized assessment and treatment plan, and thus supporting accurate diagnosis and effective care. The following graphic shows the key roles different profession in a hospital can offer to help achieve successful implementation of the GMCS.

The GMCS follows the recommended workflow of evidence-based malnutrition care and encourages interdisciplinary care discussions and involvement during implementation and clinical care. Although the GMCS was developed for the acute care setting, its proven framework can be adapted to any practice area to improve patient outcomes and quality of care. 

Benefits of implementing the GMCS:

• Providing care measured through the GMCS supports hospitals’ strategic plans to address social determinants of health and equity.
• All four components are often already established in acute care facilities.
• Addresses several clinical areas or quality indicators simultaneously, including: 
  • Nutrition Screening - The Joint Commission 
  • Social Determinants of Health and Food Insecurity - The Joint Commission, CMS, 2023 Healthcare Effectiveness Data and Information Set’s (HEDIS) Social Need Screening and Intervention Measure 
  • Health Equity Advancement - identified by CMS as a priority eCQM 
  • Rural Health Improvement- identified by NQF as a key measure** 
• Combines several quality measures into one single composite score, giving a more comprehensive picture of clinical care than a single measure.
• Promotes multidisciplinary engagement, supporting communication and employee satisfaction efforts.

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• Malnutrition Quality Improvement Initiative (MQii): a project of the Academy of Nutrition and Dietetics, Avalere Health, and other stakeholders who collaborate to provide guidance and expertise for clinical malnutrition.
  • MQii Toolkit: supports the implementation of malnutrition care best practices.
  • MQii Learning Collaborative, a community of clinicians committed to improving delivery of malnutrition care in hospitals and health systems across the US.
• Reports:  
  • Dialogue Proceedings for Advancing Patient-Centered Malnutrition Care Transitions
  • Roundtable Proceedings for Advancing Health Equity Through Malnutrition Quality Measurement
• Webinar Recordings:
  • August 2022: Global Malnutrition Composite Score
  • August 2023: Global Malnutrition Composite Score Town Hall
  • November 2023: Advancing Quality and Strengthening Interdisciplinary Collaboration (Part I) (1 free CPEU)
  • February 2024: Value of Nutrition and Dietetics Credentialed Practitioners in Optimizing Quality Outcomes from the Interdisciplinary Team Perspective (Part II) (1 free CPEU)
  • May 2024: Measuring Nutrition Practice Outcomes by Demonstrating Value in the Real World (1 free CPEU)
  • July 2024: Understanding the Global Malnutrition Composite Score: Key Insights and Major Updates for Reporting Period 2025 (1 CPEU)
• Infographics:  
  • Infographic: Hospital Value of the Global Malnutrition Composite Score (GMCS) Quality Measure
• Peer-Reviewed Articles:
  • Measuring Malnutrition and Food Insecurity to Facilitate Quality Care and Health Equity. Journal of the Academy of Nutrition and Dietetics. October 2022 Supplement.
  • The Updated Global Malnutrition Composite Score Clinical Quality Measure: Its Relevance to Improving Inpatient Clinical Outcomes and Health Equity. Journal of the Academy of Nutrition and Dietetics. February 2024.
  • The Global Malnutrition Composite Score: Impacting malnutrition care. Nutrition in Clinical Practice. June 2024.
• Additional Education Programs
  • Action Plan to Implement the GMCS
  • Business Case for Implementation of GMCS pre-recorded session (free 4.5 CPEU)
  • Malnutrition and Health Equity: Key Measures of Quality Care for Nutrition and Dietetics Practitioners (free 2.5 CPEU)
  • The Joint Commission Expert to Expert 2024 New Measure Review Webinar for the Global Malnutrition Composite Score eCQM
  • MQii August Virtual Office Hour Session
  • Click here for a list of additional CPE resources, including the Quarterly Spotlight on Quality. 

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*Reporting Period is the period where data is collected. Submission Period is when data collected the prior year is submitted, usually during the Spring Quarter. Payment Period is the fiscal year the payment could potentially be affected if criteria for reporting is met or not met. 

Additional implementation resources: 

• Freely available Nutrition Care Process terms

For additional information, questions, or support with implementation needs, please email quality@eatright.org. 

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References: 

1. Avalere Health. (2022). Leveraging Inpatient Malnutrition Care to Address Health Disparities. Retrieved July 27, 2023, from https://avalere.com/insights/leveraging-inpatient-malnutrition-care-to-address-health-disparities.
2. Barrett ML, B. M. (2018). Non-maternal and Non-neonatal Inpatient Stays in the United States Involving Malnutrition, 2016. U.S. Agency for Healthcare Research and Quality. Retrieved July 27, 2023, from https://hcup-us.ahrq.gov/reports/ataglance/HCUPMalnutritionHospReport_083018.pdf. 
3. Mueller C, Compher C & Druyan ME and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. Nutrition Screening, Assessment, and Intervention in Adults. Journal of Parenteral and Enteral Nutrition. 2011; 35 (1): 16-24. A.S.P.E.N. Clinical Guidelines (wiley.com)
4. Sriram K, Sulo S, VanDerBosch G, et al. A comprehensive nutrition-focused quality improvement program reduces 30-day readmissions and length of stay in hospitalized patients. JPEN J Parenter Enteral Nutr. 2017;41(3):384-391.
5. Sulo S, Feldstein J, Partridge J, et al. Budget impact of a comprehensive nutrition-focused quality improvement program for malnourished hospitalized patients. Am Health Drug Benefits. 2017;10(5):262- 270.
6. Tappenden, KA; Quatrara, B; Parkhurts, M; Malone, A; Fanjiang, G; Ziegler, T. (2013). Critical Role of Nutrition in Improving Quality Care: An Interdisciplinary Call to Action to Address Adult Hospital Malnutrition. J Acad Nutr and Diet. 113 (9); 1219-1237.
7. Valladares AF, Kilgore KM, Partridge J, Sulo S, Kerr KW, McCauley S. How a Malnutrition Quality Improvement Initiative Furthers Malnutrition Measurement and Care: Results From a Hospital Learning Collaborative. JPEN J Parenter Enteral Nutr. 2021 Feb;45(2):366-371.

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