Brief description of measure ​CMS986: Global Malnutrition Composite Score: This measure assesses the percentage of hospitalizations for adults aged 65 years and older prior to the start of the measurement period with a length of stay equal to or greater than 24 hours who received optimal malnutrition care during the current inpatient hospitalizations where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are screened for malnutrition risk, assessed to confirm findings of malnutrition risk, and if identified with a "moderate" or "severe"  malnutrition status in the current performed malnutrition assessment, receive a current "moderate" or "severe" malnutrition diagnosis and have a current nutrition care plan performed. Description of issue ​The measure developer recommends adding a value set, definition, and logic for "Nutrition Status Not or Mildly Malnourished" to differentiate between a negative nutrition status (i.e., no nutrition assessment problem) and no documented findings of the "Nutrition Assessment" results. To link this new content with the measure, the measure developers will also add a new definition for "Nutrition Assessment Result Identified", and propose revisions to the "Nutrition Assessment" definition and "Measure Observation 2" function.  Goal of review Obtain technical feedback

Proposed solution ​Add a proposed new value set and definition for "Nutrition Assessment of No or Mild Malnourishment", add a proposed new definition for "Nutrition Assessment Result Identified", and propose revisions for the "Nutrition Assessment" definition and "Measure Observation 2" function. PROPOSED "NUTRITION ASSESSMENT RESULT OF NO OR MILD MALNOURISHMENT" VALUE SET 248324001: Well nourished (finding) 190603003: Mild protein-calorie malnutrition (weight for age 75-89 percent of standard) (disorder) PROPOSED "ENCOUNTER WITH NUTRITION STATUS OF NO OR MILD MALNOURISHMENT" DEFINITION define "Encounter with Nutrition Status of No or Mild Malnourishment":   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Nutrition Status of No or Mild Malnourishment"] AssessmentNoOrMildResultMalnourishment         such that AssessmentNoOrMildResultMalnourishment.relevantDatetime during GlobalMalnutritionEncounter.relevantPeriod PROPOSED "ENCOUNTER WITH NUTRITION STATUS OF NO OR MILD MALNOURISHMENT" DEFINITION define "Encounter with Nutrition Status of No or Mild Malnourishment":   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Nutrition Status of No or Mild Malnourishment"] AssessmentNoOrMildResultMalnourishment         such that AssessmentNoOrMildResultMalnourishment.relevantDatetime during GlobalMalnutritionEncounter.relevantPeriod PROPOSED "ENCOUNTER WITH NUTRITION ASSESSMENT RESULT IDENTIFIED" define "Encounter With Nutrition Assessment Result Identified": ["Assessment, Performed": "Nutrition Assessment"] NutritionAssessmentResultIdentified   where ( NutritionAssessmentResultIdentified.result in "Nutrition Assessment of No or Mild Malnourishment"       or NutritionAssessmentResultIdentified.result in "Nutrition Assessment Result of Moderate or Severe Malnourishment" CURRENT MEASURE OBSERVATION 2 Measure Observation 2(Encounter "Encounter, Performed")   if ( ( "Encounter with Malnutrition Assessment" contains Encounter )       and ( "Encounter with Malnutrition Assessment" contains Encounter )   ) then 1     else 0 PROPOSED MEASURE OBSERVATION 2 Measure Observation 2(Encounter "Encounter, Performed")   if ( ( "Encounter With Nutrition Assessment" contains Encounter )       and ( "Encounter with Nutrition Assessment  Result Identified" contains Encounter )   ) then 1     else 0 Rationale for change ​The current definition and logic for the "Nutrition Assessment" does not guide implementers how to evaluate when the result of the "Nutrition Assessment" is not identified. Hospitalizations for patients who with "No or Mild Malnourishment" and those "without documentation of Nutrition Assessment Result"both meet the Measure Observation 2 clinical actions. In these instances, Measure Observation 3 "Malnutrition Diagnosis" and Measure Observation 4 "Nutrition Care Plan" would not be evaluated for performance. Patients without an identified "NutritionAssessment" result may still clinically require malnutrition interventions by the multi-disciplinary team. By adding the "Nutrition Status Not or Mildly Malnourished" Value Set, definition, and logic, as well as a new definition for "Nutrition Assessment Result Identified", and propose revisions to the "Nutrition Assessment" definition and "Measure Observation 2" function, implementers will be able to identify hospitalizations for patients who performed a "Nutrition Assessment" for clinical eligible patients, and identify those that are clinically eligible for the "Malnutrition Diagnosis" and "Nutrition Care Plan".