Composite Score Developed to Address Malnutrition in Hospitals

What is it about?

This article describes the development of the Global Malnutrition Composite Score (GMCS)—the first electronically specified composite quality measure focused on malnutrition care for hospitalized adults in the United States. Led by the Academy of Nutrition and Dietetics and Avalere Health, the initiative responds to a long-standing gap in quality reporting related to nutrition care. Initially, four individual electronic clinical quality measures (eCQMs) were developed and tested. These addressed key components of care: screening, assessment, diagnosis, and treatment planning for malnourished or at-risk patients. Their implementation demonstrated both feasibility and effectiveness in identifying care gaps and improving patient outcomes. Building on this success, a composite measure—the GMCS—was developed. It combines these four eCQMs into a single score that reflects the overall quality of malnutrition care in hospitals. The GMCS was created using best practices in composite measure development, including empirical testing for validity and reliability, and aligns with standards set by the Centers for Medicare and Medicaid Services (CMS). Ultimately, the GMCS offers a more comprehensive and actionable tool for hospitals and clinicians to assess and improve the delivery of malnutrition care, particularly for adults aged 65 and older.

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Why is it important?

Malnutrition is a major, underrecognized driver of poor health outcomes in hospitalized adults, particularly older patients. Although national data suggests 8% of hospitalized adults are diagnosed with malnutrition, real-world prevalence may be as high as 50%. Malnutrition is strongly associated with increased length of stay, 30-day readmissions, complications, and mortality—yet it remains largely absent from public quality reporting programs. The Global Malnutrition Composite Score (GMCS) addresses this care gap by offering a standardized, comprehensive quality measure. By combining four essential processes—screening, assessment, diagnosis, and care planning—into one score, the GMCS gives hospitals a powerful way to track performance and identify opportunities for improvement. It also supports value-based care models by linking nutrition care to measurable patient outcomes. Importantly, the GMCS aligns with CMS priorities around composite measures that streamline complex quality domains into single, actionable metrics. As malnutrition becomes more recognized as a healthcare quality issue, the GMCS provides a foundation for national reporting, benchmarking, and incentives tied to improving care for a high-risk population. It empowers multidisciplinary teams to ensure that nutrition is no longer an overlooked component of inpatient care quality. --------------------------- Some of the content on this page has been created using generative AI.