Performance Indicators
The Dutch Health Care Inspectorate, which is part of the Dutch Ministry of Health, has established 17 Performance Indicators on which hospitals have to report annually and which are used for benchmarking between hospitals. Screening and the treatment of malnutrition in hospitals have become part of this set of indicators since 2007. Every summer the previous year’s data are published and both the Health Care Inspectorate and the media then use them for quality rating of hospitals. In 2013, screening of hospitals outpatients has been added to the malnutrition indicator.
Literature on Performance Indicators
Leistra 2013. Systematic screening for undernutrition in hospitals: Predictive factors for success
Leistra 2009. Screening on undernutrition is mandatory in Dutch hospitals (ESPEN poster)
Performance Indicator: adult inpatients
The performance indicator on malnutrition screening in adult patients requires that all patients ≥ 18 years need to be screened within 24 hours after admission. Screening should be performed with a validated screening tool. Treatment of malnutrition is measured by the percentage of malnourished patients with an adequate protein intake (defined as: 1,2 – 1,5 gram/per kg/day) at the fourth day of hospital admission.
| Screening (adults) | ||
| Do you systematically screen nutritional status of all adult patients on admission to hospital? | Yes / No | |
| What screening tool is used for malnutrition screening? | SNAQ / MUST / other | |
| A | Number of adult patients admitted to hospital (>24 hours) in year of report * | n |
| B | Number of adult patients screened at hospital admission | n (%) |
| C | Number of adult patients screened as moderately malnourished | n (%) |
| D | Number of adult patients screened as severely malnourished | n (%) |
* Patients in maternity ward or with planned admission for < 24 hours are excluded from this measurement
| Treatment (adults) | ||
| What type of measurement was performed? (preferably continuous measurement) | Continuous / subsample | |
| A | Number of malnourished adult patients with >4 days admission | n |
| B | Number of malnourished adult patients with adequate protein intake on 4th day of admission * | n (%) |
* Optimal protein intake is defined as: 1,2 – 1,5 gram/per kg/day
Performance Indicator: children
As of 2008, screening and treatment of malnutrition in hospitalized children is part of the malnutrition indicator. For children, the treatment indicator focuses on both adequate protein and energy intake.
| Screening (children) | ||
| Do you systematically screen nutritional status of all children (< 18 years) on admission to hospital? | Yes / No | |
| What screening tool is used for malnutrition screening in children? | STRONGkids / other | |
| A | Number of children admitted to hospital (>24 hours) in year of report * | n |
| B | Number of children screened at hospital admission | n (%) |
| C | Number of children screened as malnourished | n (%) |
* Children < 28 days or with planned admission for < 24 hours are excluded from this measurement
| Treatment (children) | ||
| What type of measurement was performed? (preferably continuous measurement) | Continuous / subsample | |
| A | Number of malnourished children with >4 days admission | n |
| B | Number of malnourished children with adequate protein intake on 4th day of admission * | n (%) |
| C | Number of malnourished children with adequate energy intake on 4th day of admission ** | |
* Optimal protein intake is defined as: 1,2 – 1,5 gram/per kg/day (for children ≥ 1 year)
** Optimal energy intake is defined as: Schofield + 30% additional factor
(Ref: Schofield WN. Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 1985;39:5–41).
Performance Indicator: adult outpatients
Due to declining length of hospital stay and, consequently, shortened time to improve nutritional status during admission, outpatient screening becomes more important. Therefore, as of 2013, screening of hospital outpatients has been added to the malnutrition performance indicator. In 2013, this outpatient indicator will focus on the preoperative assessment outpatient department. It is expected that other outpatient departments (e.g. geriatrics) will be added to the indicator in the following years.
| Screening (outpatients) | ||
| Do you systematically screen nutritional status of all adult patients in the preoperative assessment outpatient department? | Yes / No | |
| What screening tool is used for outpatient screening? | MNA / MNA-SF / SNAQ / SNAQ65+ / MUST / other | |
| A | Number of first outpatient visits in year of report * | n |
| B | Number of adult outpatients screened during first outpatient visit | n (%) |
| C | Number of adult outpatients screened as malnourished | n (%) |
* This indicator involves only the preoperative assessment outpatient department