US State Hospital Regulations Rarely Include Malnutrition but Could Provide a Future Policy Framework for Improving Malnutrition Quality of Care

Malnutrition is a problem that is often not identified in hospitals as 8% of hospital patients are diagnosed but malnutrition is estimated to affect 20-50% of patients. Federal programs such as Joint Commission accreditation and the new, optional, global malnutrition composite score from CMS may improve inpatient malnutrition diagnosis, but there may be an opportunity to do more from a regulatory side. It’s unknown how many states are considering malnutrition from this standpoint. The study’s goal was to collect baseline information on mentions of malnutrition-related terms in state hospital regulations. State hospital regulations were identified in July 2022 using this website https://www.hortyspringer.com/list-links-state-hospital-regulations/ with each regulation double checked each to ensure the most updated guidelines. Hospital regulations from each state plus Washington D. C. (n = 51) were searched for number of mentions of nutrition and malnutrition and whether terms were included in a nutrition care section. Nutrition was mentioned in 82% of plans, but only 49% included nutrition in a nutrition care process section. Malnutrition was mentioned infrequently, with only three states (6%) mentioning malnutrition and only two states (4%) mentioning malnutrition in a nutrition care section. There was only one significant difference in frequency of term mentions by US region (average in Midwest 4.69, in Southeast 24). Incorporating malnutrition and nutrition care processes into state hospital regulations and defining enforcement of regulations may help increase inpatient identification of malnutrition.