Applying Quality Improvement, the Nutrition Care Process & Terminology (NCP/T), and Interoperability Standards to Practice

The healthcare world has greatly transformed in the last century (Marjoua Y). With quality measures driving decision-making, it has become imperative for nutrition and dietetics professionals to understand and apply quality management principles in their practice. In addition, with the transition in quality measures towards interoperability, it is key that nutrition and dietetic students and interns graduate with an understanding of information technology and its application to quality measures and data reporting. Moreover, in the process of standardizing systems, the Nutrition Care Process (NCP) becomes an essential framework for applying evidence-based nutrition and dietetics knowledge while ensuring high-quality care.

This resource guide supports educators and preceptors in providing knowledge on the core basics of quality improvement, the NCP, and information technology. Developed by subject matter experts and members of the Academy’s Quality Management Committee, Nutrition Care Process and Terminology Committee, and Interoperability and Standards Committee, this guide will also explain how these three topics interconnect and apply to the successful implementation of the Malnutrition Care Score (MCS),ultimately demonstrating the value of the nutrition and dietetics professional.

Learning Objectives of this Resource Guide

1. Analyze how quality improvement (QI), the Nutrition Care Process and       Terminology (NCP/T), and interoperability standards influence nutrition care delivery, documentation accuracy, and measurable outcomes across healthcare settings.

2. Identify the steps and key elements that support credentialed practitioners in achieving nutrition care quality.

3. Apply QI principles, NCP/T, and interoperability standards to design and implement evidence-based solutions that improve patient outcomes and support accreditation competencies.

 

Dietetic Educators and Preceptor Responsibilities

1. Review the activities in this document in advance.
2. Meet with the learner to discuss this Resource Guide.
3. Guide the learner through the activities as needed.
4. Provide ongoing support and communication with the learner while reviewing areas for improvement and highlighting strengths.
5. Evaluate the learner’s work using the coordinating evaluation form after the completion of each activity.

The Institute of Medicine (IOM) has defined healthcare quality as “the degree to which health care services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge.” (Seelbach CL; Institute of Medicine (US) Committee to Design a Strategy for Quality Review and Assurance in Medicare) Nutrition and dietetics credentialed practitioners are part of the interdisciplinary team in a variety of care settings, which support not only access to patient-centered health care but also address nutrition for the purpose of prevention.

This section provides dietetics students with an introductory guide to QI principles and methodologies that can be used to support quality care and process improvement in nutrition and dietetics practice. Learners will explore key QI concepts such as Lean Six Sigma and Plan-Do-Study-Act (PDSA) cycles to improve patient outcomes and enhance efficiency, while gaining practical skills in identifying improvement opportunities, designing interventions, and measuring success in nutrition care processes. Ultimately, this activity seeks to empower learners to lead and participate in QI initiatives, contributing to higher standards of care.

 

Learner Objectives

The learner will be able to:

● Analyze the purpose behind quality improvement processes to support services and patient outcomes within various food, nutrition, and dietetics organizations.

● Identify key aspects of QI principles and methodologies that support quality improvement processes across care settings.

● Apply quality improvement techniques and methodologies to a case study, with the goal of defining the problem, suggesting interventions, and evaluating the success of the proposed interventions.

1. Read the information on these pages:

• Quality Management - PubMed (www.pubmed.ncbi.nlm.nih.gov/32491437/)
• Brief history of quality movement in US healthcare (www.pmc.ncbi.nlm.nih.gov/articles/PMC3702754/pdf/12178_2012_Article_9137.pdf)
• Quality Measurement and Quality Improvement | CMS (www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-)
• Careers in Quality Handout

2. Read the article Why healthcare leadership should embrace quality improvement | The BMJ (www.bmj.com/content/bmj/368/bmj.m872.full.pdf)

3. Watch this video: Quality Improvement 101 Presentation | Commission on Dietetic Registration (www.pathlms.com/cdr/courses/52173/video_presentations/267180)

With the information learned in step #1 in mind:

• View the recording linked here: Quality and Process Improvement Basics for Nutrition and Dietetic Practitioners | Commission on Dietetic Registration
• Read the Reference Guide: Getting Started with QI

For each of the below, specify

• the type (QI Methodology, Root Cause Analysis, Waste Analysis)
• a brief description or steps to this methodology
• benefits
• disadvantages

Take what you learned in steps 1-2 and put it into practice. Read the below examples of problems credentialed practitioners have experienced in different types of organizations.
 

1. In an acute care facility, RD orders daily weights for patients on parenteral nutrition. Nursing staff then change orders to weekly weights to support their flow of work.
2. In an acute care facility, nursing is concerned that patients with high blood sugars are receiving snacks by standing orders. Their proposed solution is to discontinue the standing order.
3. In a long-term care facility, weekly weights are expected to be measured. When there is a need for daily weights, nursing does not seem to be as effective in following the order.
4. In a long-term care facility, ordered oral nutrition supplements are not being given but nursing is documenting the supplements as provided.
5.  A public health department has one part-time RD serving the whole community, but the need for care exceeds the time the RD can provide.
6. In the food service department of a large hospital, the director is experiencing issues with keeping the temperature at an acceptable level to keep foods safe, palatable, and appealing to patients.
7. A small rural hospital wants to offer freshly cooked meals, but the available staff is limited and lacks the skills and ability to accomplish this goal.
8. An oncology clinic has an RD, but it does not have a process in place to guide referrals to the nutrition clinic. The RD must assess all admitted patients causing a decrease in the RD’s available time to see patients.

Familiarize yourself with the organization’s strategic plan, mission, vision, and goals (as they may apply). Meet with credentialed practitioners in your facility. Ask them these questions

1. What are weaknesses of the processes established that affect your ability to work effectively and efficiently?
2. What are standards, policies, regulations, and laws that you have no control over but affect the services offered?

 

ACTIVITY

1. Define one problem most of the organization’s practitioners confront in providing services that meet the client/patient needs and is it effective/efficient. To support this, you can reference section I of this Process Improvement Action Plan Worksheet.

As an alternative, think of a problem or issue you experienced recently, something you thought to yourself, “maybe there is a better way to do this or to meet the goals.” It could be at work, in class, or with family.

2. Visit with the credentialed nutrition and dietetics practitioners. Be ready to write down what they say. It may be better to use a board or a shared screen, but paper can be used as well. Present the problem outlined above and ask them why they think this is the case. Continue asking why 5 or more times, or until a practical root cause is discovered. Watch this video for more information on the 5 Why’s, www.youtube.com/watch?v=0rnjQfLvlm4.

3. If time allows, ask these questions related to the problem and the processes around the problem: (i) What about this process is working well? (ii) What about this process does not work well? (iii) What benefits could result from addressing this problem?

 

4. Additional optional reading material, as time allows:

1. Blankenship J, Blancato RB, Kelly R. Quality Improvement as the Foundation for Health Care Advancement. J Acad Nutr Diet. 2019 Sep;119(9 Suppl 2): S15-S17. doi: 10.1016/j.jand.2019.05.026. PMID: 31446939.
2. Meehan A, Loose C, Bell J, Partridge J, Nelson J, Goates S. Health System Quality Improvement. J Nurs Care Qual. 2016;31(3):217-223. doi:10.1097/NCQ.0000000000000177

Knowledge Check

Present your findings to the Nutrition and Dietetics team at the organization. If this is not possible, develop a written report with your findings. Present the report to the Nutrition and Dietetics team leader or your proctor. If additional input is desired, email the report to quality@eatright.org.

Accurate identification and documentation of malnutrition are important for ensuring high quality patient care, supporting accurate reimbursement, and demonstrating the value of credentialed nutrition professionals. Inconsistent malnutrition documentation can lead to miscommunication and missed opportunities to improve patient outcomes. This activity introduces students to identifying barriers to accurate malnutrition identification and documentation, constructing strategies to improve documentation using Nutrition Care Process terminology, and analyzing data to evaluate the impact on patient outcomes. By completing this activity, students will strengthen their problem-solving skills by applying data-driven approaches to improve malnutrition documentation using quality improvement frameworks.

 

Learning Objectives

The learner will be able to:

● Identify two barriers and related solutions for the accuracy of malnutrition identification and documentation (e.g., problem resolution focused objective)

● Construct an approach to improve identification and documentation of malnutrition, using aggregated nutrition care process terminology data queried from EHRs.

● Analyze data collected to determine the impact on client outcomes and the effectiveness of care.

Tasks to Be Completed

 Prior to beginning the activity, familiarity with the following citations is recommended.

1. Kight CE, Bouche JM, Curry A, et al. Consensus Recommendations for Optimizing Electronic Health Records for Nutrition Care. Nutr Clin Pract. 2020;35(1):12-23. doi:10.1002/ncp.10433
2. Lewis SL, Miranda LS, Kurtz J, Larison LM, Brewer WJ, Papoutsakis C. Nutrition Care Process Quality Evaluation and Standardization Tool: The Next Frontier in Quality Evaluation of Documentation. J Acad Nutr Diet. 2022;122(3):650-660. doi:10.1016/j.jand.2021.07.004
3. Lewis SL, Wright L, Arikawa AY, Papoutsakis C. Etiology Intervention Link Predicts Resolution of Nutrition Diagnosis: A Nutrition Care Process Outcomes Study from a Veterans' Health Care Facility. J Acad Nutr Diet. 2021;121(9):1831-1840. doi:10.1016/j.jand.2020.04.015
4. Swan WI, Vivanti A, Hakel-Smith NA, et al. Nutrition Care Process and Model Update: Toward Realizing People-Centered Care and Outcomes Management. J Acad Nutr Diet. 2017;117(12):2003-2014. doi:10.1016/j.jand.2017.07.015
5. Swan WI, Pertel DG, Hotson B, et al. Nutrition Care Process (NCP) Update Part 2: Developing and Using the NCP Terminology to Demonstrate Efficacy of Nutrition Care and Related Outcomes. J Acad Nutr Diet. 2019;119(5):840-855. doi:10.1016/j.jand.2018.10.025

Additional suggested readings:

1. Colin C, Arikawa A, Lewis S, et al. Documentation of the evidence-diagnosis link predicts nutrition diagnosis resolution in the Academy of Nutrition and Dietetics' diabetes mellitus registry study: A secondary analysis of Nutrition Care Process outcomes. Front Nutr. 2023;10:1011958. doi:10.3389/fnut.2023.1011958

2. Hakel-Smith N, Lewis NM, Eskridge KM. Orientation to nutrition care process standards improves nutrition care documentation by nutrition practitioners. J Am Diet Assoc. 2005;105(10):1582-1589. doi:10.1016/j.jada.2005.07.004

3.  Lamers-Johnson E, Kelley K, Sánchez DM, et al. Academy of Nutrition and Dietetics Nutrition Research Network: Validation of a Novel Nutrition Informatics Tool to Assess Agreement Between Documented Nutrition Care and Evidence-Based Recommendations. J Acad Nutr Diet. 2022;122(4):862-872. doi:10.1016/j.jand.2021.03.013

4. Thompson KL, Davidson P, Swan WI, et al. Nutrition care process chains: the "missing link" between research and evidence-based practice. J Acad Nutr Diet. 2015;115(9):1491-1498. doi:10.1016/j.jand.2015.04.014

Read the following NCP QI Malnutrition Diagnosis Project Case Scenario

Smith Hospital has four registered dietitians/nutritionists (RDNs) in the General Medicine unit. They are responsible for an average daily census of 90-100 patients. The RDNs utilize the Nutrition Care Process and standardized terminology to complete their assessments. They regularly use the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (ASPEN) indicators to diagnose malnutrition (AAIM).

During a meeting with leadership, the Clinical Nutrition Manager (CNM) received feedback from a representative of the clinical coding and documentation specialists that there had been an increase in payor denials for malnutrition diagnoses. This also correlated with an increase in queries to providers for additional malnutrition-related documentation. The CNM decided to initiate a limited Plan-Do-Study-Act (PDSA) project cycle targeting 

malnutrition and its documentation for patients on the general medicine service. (For information on PDSA, please complete Activity 1)

Initial investigation by the CNM revealed that the department’s policy for the assessment and diagnosis of malnutrition was vague and did not outline specific criteria for the identification and documentation of malnutrition. A small sample review of the RDNs' charting in the Electronic Health Record (EHR) showed inconsistencies in the use of terminology for diagnosing malnutrition. All RDNs were writing PES statements, but some of the RDNs used Nutrition Care Process standardized terminology while others used phrases such as protein-calorie malnutrition, unspecified malnutrition, undernutrition, protein-energy malnutrition, and deficiency of macronutrients. Documentation of the acuity (degree) of malnutrition was inconsistent, i.e., sometimes the degree of severity was unspecified, sometimes the degree of severity was noted as moderate when it should have been severe. The team was also using free text for their charting instead of the drop-down menus offered by the EHR system. Overall, this brief chart review confirmed that the CNM needed to look further into their policy and practices for the assessment and diagnosis of malnutrition.

QI Project Design*

Based on the feedback from the clinical coding and documentation specialists and the information obtained from the small chart review of RDN documentation, the CNM decides to do the following:

● Evaluate the accuracy of malnutrition identification, specifically the severity of malnutrition, using the AAIM criteria.

● Evaluate the use of standardized terminology for the documentation of malnutrition problem statements.

Knowledge Check

1. Evaluate the data*

The CNM collected documentation on 167 patients over a two-week period. This included 150 patients assessed by the dietitians as well as all patients diagnosed with malnutrition.

Review chart 1 (below). The CNM found that 8 patients were diagnosed with malnutrition who did not meet the criteria and eight were not diagnosed with malnutrition when they met criteria per AAIM guidelines.

Chart 1 

#	Agreement of RD Assessment Criteria and RD Malnutrition Dx
8	RD documented >=2 criteria and did not diagnose malnutrition (incorrect outcome)
8	RD Documented <2 criteria and diagnosed malnurition (incorrect outcome)
34	RD documented >=2 criteria and diagnosed with malnutrition (correct outcome)
100	RD Documented <2 criteria and did not diagnose malnurition (correct outcome)

 

Review chart 2 (below). The CNM found that 110 (73.3%) of the diagnoses used language consistent with the AAIM criteria. Of the remaining 40 patients, eight should have been diagnosed with “Moderate” malnutrition rather than “None”. These are considered missed diagnoses. Twenty-one patients only had “malnutrition” documented but after reviewing the criteria documented by the dietitian, eight did not meet AAIM criteria, six should have been classified as “Moderate”, and seven as “Severe”. These are considered missed diagnoses. Finally, six were diagnosed with “Severe” malnutrition but only met the criteria for “Moderate”.

Chart 2: Documentation Agreement Between AAIM Criteria and RD Malnutrition Dx

	AAIM	Malnutrition	Criteria
RD Malnutrition Documentation	None	Moderate	Severe	Total
None	100	8	0	108
Malnutrition	8	6	7	21
Mild Malnutrition	0	0	0	0
Moderate Malnutrition	0	5	5	10
Severe Malnutrition	0	6	5	11
Protein Calorie Malnutrition	0	0	0	0
Total	108	25	17	150

Clinical documentation specialists rely exclusively on provider diagnoses for billing purposes. However, evaluating the level of agreement between provider and dietitian documentation is essential to identify missed or misclassified cases of malnutrition. In the reviewed data (Charts 3 and 4), dietitians and providers agreed on the presence of malnutrition in 93.3% of cases. Discrepancies were noted in ten cases—four where the dietitian documented malnutrition, but the provider did not, and six where the provider diagnosed malnutrition, but the dietitian did not. Additionally, there were 17 instances in which providers documented malnutrition independently, without a corresponding dietitian assessment, because provider diagnoses do not require RDN input.

 

Chart 3-Malnutrition Dx of Patients Assessed by Both the RD and Provider

 

Like the comparison between dietitians’ documentation and AAIM diagnostic criteria, the Clinical Nutrition Manager (CNM) also assessed the level of agreement between dietitian and provider documentation of malnutrition severity (Chart 5). The table outlines the number and types of malnutrition diagnoses documented by each group. Notably, dietitians did not use the terms “Mild” or “Protein-calorie malnutrition,” which were documented only by providers.

 

Chart 5-Malnutrition Documentation for Patients Assessed by an RD and/or Diagnosed with Malnutrition by a Provider

 

Accurate, standardized nutrition documentation is critical for supporting interoperability, enhancing communication among healthcare providers, and improving patient outcomes. When documentation lacks consistency or structure, essential data can be lost, misinterpreted, or become difficult to share across healthcare systems. This activity introduces students to the role of information technology, interoperability, and standards in strengthening nutrition documentation practices. Students will practice completing a severe malnutrition case study by identifying key nutrition data elements, such as anthropometric measurements, biochemical values, and intake history, and mapping them to standard coding systems, including Nutrition Care Process (NCP) Terminology, LOINC, ICD-10, and SNOMED CT.

By completing this activity, students will develop skills in applying structured documentation methods, recognize the value of coding and standards in promoting data exchange, and reflect on how interoperability supports quality initiatives and coordinated care.

 

Learning Objectives

The learner will be able to:

● Examine key data standard organizations that influence healthcare quality improvement.

●  Identify standardized interoperability terminology (see Appendix C) for data exchange and accuracy.

● Interpret types of data used in healthcare (e.g., discrete, non-discrete).

 

Tasks to Be Completed

1.      Familiarize yourself with the data standards and resources (as seen in Appendix C):

   a.  HL7 FHIR: What is it, Really?

   b.  Interoperability for Health Overview

   c.  VSAC- Value Set Authority Center

 

2.      Review the identified and listed material, and the documentation example provided below. These resources will help you understand the context and details needed to complete the activity.  

   a.   HL7

   b.   ICD

   c.    LOINC

   d.    NCP

   e.    SNOMED

   f.      Interoperability and Health Information Standards

   g.    November 2024: Harnessing the Power of Data by Elevating Documentation to Enhance Patient Care - https://www.pathlms.com/cdr/courses/86875

(start video at 3:42 On data types)

  h.    Healthcare coding systems - Overview https://www.imohealth.com/resources/medical-coding-systems-explained-icd-10-cm-cpt-snomed-and-others/

Documentation Example  

Unstructured note moderate malnutrition: 

83 yo F DX: weakness, depression vs UTI. Pt was in the hospital previously with weakness and discharge. States that when she monitors her blood sugar, it is “normal,” did not elaborate on numbers, but states she takes her meds (oral) as prescribed. Her A1C in November of 2023 was 11.2. Weight loss reported does not align with documentation and exceeds actual measured weight. Pt reports 20 to 40 lbs of weight loss in last two visits (about two weeks) but cannot verify in records, however physician notes possible muscle wasting and poor po for an unspecified time period.  Pt meets criteria for moderate malnutrition.  

Note translated with structured data fields (drop-down lists):

3. Using the documentation example, study the tables below in the Moderate Malnutrition Case Study. As you work through the tables, focus on identifying how and which parts of the nutrition documentation could be made interoperable within healthcare systems.  

 Pay close attention to specific data elements, such as anthropometric measurements, biochemical values, and intake history, that are relevant for nutrition documentation. Consider how these elements can be coded or structured using standard systems such as the Nutrition Care Process /Terminology (NCP/T), LOINC, ICD-10, or SNOMED CT to support interoperability. Reflect on how standardizing documentation can improve data sharing and care coordination among interdisciplinary teams. 

 

Non-Discrete	Why?
Monitoring blood sugar as “normal”	Lacks quantification
Reported weight loss	Not verified in record, may be subjective
Hospitalization history	Narrative lacking metrics

 

Discrete Data	Code System
Age-83	HL7
Sex-female	HL7, SNOMED CT
Weakness	ICD-10, SNOMED CT
Depression	ICD-10, SNOMED CT
UTI	ICD-10, SNOMED CT
A1C-11.2%	LOINC
Medication compliance	SNOMED CT
Moderate malnutrition	ICD-10, SNOMED CT, NCP

By the end of this activity, you will have a clearer understanding of how structured nutrition documentation enhances interoperability and contributes to better healthcare outcomes.  

Unstructured note Severe malnutrition:

74 YO F w/ PMH: psych history, cognitive impairment, HTN. Per H&P pt lives at a board & care. Pt sent to ED r/t weakness and unable to get out of bed. Dx: FTT, cachexia, mild hyponatremia, hypokalemia, elevated BG (383 High on admit). Pertinent Labs:   BG 110-383 x24hrs (33% WDL), A1C 6.3, K+ 3.1 Low > 3.6 WDL SLP assessed pt this am and deemed pt appropriate for PU4 textures. 

 

RD attempted to interview pt but she was unable to answer RD's questions. Unable to assess or obtain diet hx or wt hx from pt. She was also focused on getting out of bed. Sitter is at the bedside. Pt requires constant reminders to stay in bed. 

 

RD performed NFPE, though this was limited r/t pt's cooperation. Able to discern that pt w/ severe muscle and subq fat loss.  

 

Nutrition Focused Physical Exam:   

Unable to fully assess NFPE r/t pt's lack of cooperation. 

Orbitals: Hollow look, depressions, dark circles, loose skin (severe subq fat loss) 

Temples: Hollowing, scooping, depression (severe muscle loss) 

Clavicles: Protruding, prominent bone (severe muscle loss) 

Acromion: Shoulder to arm joint looks square. Bones prominent. Acromion protrusion very prominent (severe muscle loss) 

Scapular: Prominent, visible bones, depressions between ribs/scapula or shoulder/spine (severe muscle loss) 

Lumbar region: Iliac crest very prominent (severe subq fat loss) 

Anterior thighs: Depression/line on thigh, obviously thin (severe muscle loss) 

Posterior calf regions: Thin, minimal to no muscle definition (severe muscle loss) 

 

Per initial nutritional screening, unsure if pt has lost weight recently without trying, and unable to assess if pt eating poorly because of a decreased appetite. EMR is limited w/ pt's wt hx and does not include scaled weights. 

 

In the United States, patients and families use quality measures to select high-performing clinicians, while healthcare providers use them to assess their own performance (Center for Medicare & Medicaid Services). The Malnutrition Care Score (MCS) is the first nutrition-focused electronic clinical quality measure (eCQM) under the Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient Quality Reporting (IQR) Program. Although developed to be implemented in acute care facilities, the MCS is based on an evidence-based malnutrition care framework that can be implemented as a quality improvement process in any care setting. This section aims to introduce students to the basics of malnutrition care and the leadership role that nutrition and dietetics credentialed practitioners have in addressing malnutrition. With this, students will learn about the Malnutrition Care Score and how its framework supports evidence-based malnutrition care and measurable quality outcomes to support patient care.

 

Learning Objectives

The learner will be able to:

● Analyze the components of the Malnutrition Care Score and its evidence-based framework to understand its application for quality outcomes measurement in various care settings.

● Identify the clinical and operational impact of malnutrition in the acute care setting and the value nutrition and dietetics credentialed practitioners provide.

● Apply Quality Improvement, NCP, and interoperability standards concepts to the steps necessary to implement the Malnutrition Care Score in an acute care facility.

 

Tasks to Be Completed

1. Review the recording that explains the basics of the Malnutrition Care Score, found at https://www.pathlms.com/cdr/courses/69286.

2. Review the webpage Malnutrition Care Score. Pay close attention to the MCS Implementation Resources section. Review the resources for the most recent available year.      

3. Visit the MCS Score Calculator. Practice with the following scenarios:

 

 Additional optional resources:

a. Video: Understanding the Global Malnutrition Composite Score: Key Insights and Major Updates for Reporting Period 2025, found at https://www.pathlms.com/cdr/courses/73674.

b. Webinar: Advancing Nutrition in Acute Care Settings: 2025 Malnutrition Quality Measure Updates and Implementation Strategies, found at www.pathlms.com/cdr/courses/112043

c. McCauley SM, Mitchell K, Heap A. The Malnutrition Quality Improvement Initiative: A Multiyear Partnership Transforms Care. J Acad Nutr Diet. 2019;119(9 Suppl 2):S18-S24. doi:10.1016/j.jand.2019.05.025.

d. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical Role of Nutrition in Improving Quality of Care. Journal of Parenteral and Enteral Nutrition. 2013;37(4):482- 497. doi:10.1177/0148607113484066.

e. Wills‐Gallagher J, Kerr KW, Macintosh B, Valladares AF, Kilgore KM, Sulo S. Implementation of malnutrition quality improvement reveals opportunities for better nutrition care delivery for hospitalized patients. Journal of Parenteral and Enteral Nutrition. 2022;46(1):243-248. doi:10.1002/jpen.2086 27

f. Gollins, LA, et al. Applying the Malnutrition Care Score Framework to Pediatric Populations: Implications for Enhancing Health Equity. Journal of the Academy of Nutrition and Dietetics, Volume 125, Issue 9, S10 - S16. Found here: www.jandonline.org/article/S2212-2672(25)00191-1/fulltext.

g. Pertel, DG, et al. 2025 Updates to the Malnutrition Care Score: Expanding Age Criteria to Enhance Malnutrition Care and Improve Health Equity. Journal of the Academy of Nutrition and Dietetics, Volume 125, Issue 9, S53 - S59. Found at www.jandonline.org/article/S2212-2672(25)00193-5/fulltext.

h.  Ashafa, M, et al. Bridging Quality, Interoperability, and Terminology Through the Updated Malnutrition Care Score. Journal of the Academy of Nutrition and Dietetics, Volume 125, Issue 9, S60 - S68. Found at www.jandonline.org/article/S2212-2672(25)00194-7/fulltext.

Using the key below, please complete the blanks in this table.

MO = Measure Observation

DR = Dietitian Referral

Y = Yes

N = No

N/A = Not Applicable

MO1 = Measure Observation 1, Malnutrition Risk Screening

MO2 = Measure Observation 2, Nutrition Assessment

MO3 = Measure Observation 3, Provider Malnutrition Diagnosis

MO4 = Measure Observation 4, Nutrition Care Plan

MO5 = Total Malnutrition Component Score = MO1+MO2+MO3+MO4

MO6 = Total Malnutrition Care Score as % = MO5 ÷ Eligible Occurrences x10

Please go here to complete Activity 5: https://eatright.jotform.com/261433513405044