Date of Award

Fall 11-17-2018

Document Type


Degree Name

Master of Science (MS)


Human Ecology

First Advisor

Janet Pope


Malnutrition increases the cost of healthcare and is commonly unrecognized and untreated. These facts are especially true for healthcare settings that provide care to the elderly. Research emphasizes the need for malnutrition prevention in extended care facilities such as skilled nursing facilities (SNFs) so that patients receive timely and appropriate intervention(s).

The purpose of this study was to retroactively screen SNF patients using four alternative malnutrition screening tools and to compare results to those from the facility screening tool. A second purpose was to estimate differences in potential Medicare reimbursement based on the number of patients identified at risk for malnutrition/malnourished using each tool. The screening tools were the OakBend Medical Screening tool (facility tool), Mini Nutrition Assessment-Short Form (MNASF), Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening 2002 (NRS-2002), and Malnutrition Screening Tool (MST).

Retrospective data from 200 SNF elder patients aged 65 years and older admitted between March 2017 and March 2018 were used for analysis. Retrospective screening allowed for comparisons among the five tools. Comparison of the number of patients categorized as no risk and at risk/malnourished using the five screening tools and differences in theoretical reimbursement were tested using chi-squared analysis.

MNA-SF identified the highest number of at risk patients (n = 181; 90.5%), while MUST identified the fewest (n = 68; 34.0%). MNA-SF produced the highest amount of malnutrition and overall theoretical dollar reimbursement value. For this study, MNA-SF and NRS-2002 showed to be the most appropriate screening tools for SNF setting. In comparison to the OakBend Medical Center screening tool, using numbers from MNASF and NRS-2002 would have generated significantly more dollars in Medicare reimbursement, respectively. In order to ensure maximum reimbursement for skilled nursing care for elders, it is essential to document the risk of malnutrition, and screening is an important first step.