This month in TWC, learn about the history of total parenteral nutrition and how the Space Race of the 1960’s helped patients with malabsorption. I explain why QCDR quality measures have been a disappointment for all specialties, why Practice Improvement Activities (IAs) are the way forward, and how wound care practitioners can improve patient nutritional status with the USWR Nutritional Assessment IA.   

“ . . . In one of my most memorable chance encounters, Dr. Dudrick summarized the history of total parenteral nutrition (TPN).  . .a story of passion and tenacity in the face of setbacks. . . In the 1960’s, my Father was part of an experiment in oral feeding . . .a physiologist at the School of Aerospace Medicine in San Antonio, Texas . . . there was a nagging problem – what were the astronauts going to EAT?”  https://www.todayswoundclinic.com/articles/nutrition-wound-healing-and-standing-shoulders-giants

I am sorry to say that it has taken me years to understand the importance of nutrition in patients with non-healing wounds. Dehisced surgical wounds affect 15% of Medicare patients and are the most prevalent and most expensive wound type in the U.S. Most surgical dehiscences are due not to infection, but nutritional problems.
The US Wound Registry has developed a nutritional screening quality measure for patients with nonhealing wounds and ulcers which can be used as a Practice Improvement Activity (IA) reportable in the Merit Based Incentive Payment System (MIPS). The American Academy of Dietetics has spearheaded a quality initiative focused on the nutritional screening hospitalized patients.  This issue of TWC has articles on both of those initiatives. Participating in the USWR nutritional assessment IA is a way to protect Medicare reimbursement for many advanced therapeutics.. While protecting revenue may be good motivation to start an IA focused on the nutritional assessment of patients with wounds, the real reason is to improve the quality of their care and the outcome of their wounds.