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Simply Delivered Meals: A Tale of Collaboration
Sarah L. Martin, PhD; Nancy Connelly, MBA; Cassandra Parsons, PharmD; and Katlyn Blackstone, MS, LSW
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Simply Delivered Meals: A Tale of Collaboration

Sarah L. Martin, PhD; Nancy Connelly, MBA; Cassandra Parsons, PharmD; and Katlyn Blackstone, MS, LSW
Offering a meal delivery service to patients in a community-based care transition program was associated with cost savings and a 38% lower 30-day hospital readmission rate.
DISCUSSION

Based on a literature review (2004-2014), Taylor and colleagues7 summarized the impact of social service investments on health outcomes and healthcare costs. More than 80% of these studies reported positive effects on either health outcomes (62.5%) or costs (15.6%) or both (22.0%). The authors stress that additional research addressing both health and cost outcomes and evidence of cost savings will be essential for more widespread endorsement. We were able to examine a proxy for health status (30-day hospital readmissions) and to calculate costs, providing further evidence for both.

In our analyses, the 30-day readmission rate for those receiving coordinated care transition and SDM was 38% lower than baseline, although the difference was not statistically significant. Being enrolled only in CCTP (vs CCTP plus SDM) was also associated with a reduction in the readmission rate. Indeed, we need comprehensive approaches for mitigating “posthospital syndrome,” a condition described by Krumholz,12 which suggests that these approaches need to target stressors that contribute to the high baseline rate of readmissions. Having a resource, such as a CCTP transition coach or delivered meals, can alleviate many of the likely stressors that patients face once they return home.

A synthesis of 9 studies of coordinated care found that 4 of the coordinated care interventions showed decreased healthcare costs and 2 others had positive health outcomes. The 2 that included outreach (eg, home-delivered meals) showed both lower costs and improved outcomes.7 The authors also synthesized 11 nutritional support studies and found that 7 showed improved health outcomes, but none showed decreased healthcare costs. In contrast, our analyses showed an association with both cost savings and positive health outcomes.

SDM is similar to Meals on Wheels, which has demonstrated a wide array of beneficial effects.13 Zhu and An14 reviewed 8 studies on home delivery of meals to older adults and found that the majority reported significant improvement in diet quality and nutrient intake, reduced food insecurity and nutritional risk, and other benefits, such as increased socialization and higher quality of life. The authors concluded that home-delivered meals help older adults maintain independence and remain in their homes.

The coordinated care transition intervention in our report can be compared with the Bridge Model,15 which combines care coordination, case management, and patient engagement. The model, like the CCTP, is designed to provide a seamless transition and improve the overall quality of transitional care for older adults. The authors of the Bridge Model study believe that the emphasis on value and quality support further development and expansion of transitional care strategies, which offer promising avenues to fulfill the Triple Aim while also impacting population health and controlling per capita costs.15 Gottlieb and colleagues16 noted barriers to widespread adoption of these collaborations across disciplines (eg, there are no medical codes to bill for social services and collaborations are challenged by various care delivery models, organizational structures, and financial contracting systems). Indeed, in the present report, external grant funding was an essential element, without which the SDM program ceased.

Practice Recommendations

Our recommendations are to: (1) establish a plan for patients discharged to skilled nursing facilities before returning home; (2) ensure that dietary restrictions are identified by the transition coach and confirmed by site staff before the meals are delivered (eg, food allergies or need for pureed, vegetarian, or renal-sensitive meals); (3) brand SDM, to distinguish the program from Meals on Wheels, which some perceived negatively as a program for a frail and low-income population; and (4) consider the effects of home-delivered meals on caregivers.

Limitations

One limitation of our report was that the analyses were limited to just 1 hospital with 622 patients, although there were more than 1000 participants. Although we cannot reliably generalize our findings to other hospitals, we believe that the sample size and 2-year duration are sufficient to suggest potentially beneficial effects. We do not have access to the data for further analyses to explore the potential bias of our sample that volunteered for SDM. Our cost estimates are valid for this hospital but, again, perhaps not generalizable, as baseline costs for the high-risk patients were quite high ($16,320 per patient).

CONCLUSIONS

Despite these limitations, we observed an association with positive outcomes for adopting coordinated care at transition, and even more so when accompanied by home-delivered meals. Our findings also suggest that it can be cost-saving to the healthcare system involved. We hope that, moving forward, barriers to collaboration will be overcome and that social determinants of health can be addressed as common practice. 

Acknowledgments

The authors would like to acknowledge Rocket Wong, formerly of MMC (Portland, Maine), for the original analyses of these data and for the abstraction of the deidentified MMC data. They would also like to acknowledge Dan Knox of SMAA for his reanalysis of the data for this manuscript.

Author Affiliations: Husson University School of Pharmacy (SLM, CP), Bangor, ME; Southern Maine Agency on Aging (NC, KB), Scarborough, ME.

Source of Funding: None.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (NC, KB); acquisition of data (NC); analysis and interpretation of data (SLM); drafting of the manuscript (SLM, CP); critical revision of the manuscript for important intellectual content (SLM, NC, CP, KB); administrative, technical, or logistic support (NC, CP); and supervision (KB).

Address Correspondence to: Nancy Connelly, MBA, Southern Maine Agency on Aging, 136 US Rte 1, Scarborough, ME 04074. Email: nconnelly@smaaa.org.
REFERENCES

1. Koo D, O’Carroll PW, Harris A, DeSalvo KB. An environmental scan of recent initiatives incorporating social determinants in public health. Prev Chronic Dis. 2016;13:E86. doi: 10.5888/pcd13.160248.

2. Maslow AH. Motivation and Personality. Oxford, UK: Harpers; 1954.

3. Bradley EH, Elkins BR, Herrin J, Elbel B. Health and social services expenditures: associations with health outcomes. BMJ Qual Saf. 2011;20(10):826-831. doi: 10.1136/bmjqs.2010.048363.

4. Health outcomes and cost: a 166-country comparison. The Economist Intelligence Unit website. eiu.com/public/topical_report.aspx?campaignid=Healthoutcome2014. Published 2014. Accessed September 21, 2016.

5. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. doi: 10.1377/hlthaff.27.3.759.

6. Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. Cambridge, MA: Institute for Health Care Improvement; 2012.

7. Taylor LA, Tan AX, Coyle CE, et al. Leveraging the social determinants of health: what works? PLoS One. 2016;11(8):e0160217. doi: 10.1371/journal.pone.0160217.

8. Bousquest J, Addis A, Adcock I, et al; European Innovation Partnership on Active and Healthy Ageing, Action Plan B3; Mechanisms of the Development of Allergy, WP 10; Global Alliance against Chronic Respiratory Diseases. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J. 2014;44(2):304-323. doi: 10.1183/09031936.00014614.

9. New requirement for 501(c)(3) hospitals under the Affordable Care Act. Internal Revenue Service website. irs.gov/charities-non-profits/charitable-organizations/new-requirements-for-501c3-hospitals-under-the-affordable-care-act. Updated August 27, 2017. Accessed September 16, 2016.

10. Deschodt M, Devriendt E, Sabbe M, et al. Characteristics of older adults admitted to the emergency department (ED) and their risk factors for ED readmission based on comprehensive geriatric assessment: a prospective cohort study. BMC Geriatr. 2015;15:54. doi: 10.1186/s12877-015-0055-7.

11. Leppin AL, Gionfriddo MR, Kessler M, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med. 2014;174(7):1095-1107. doi: 10.1001/jamainternmed.2014.1608.

12. Krumholz HM. Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med. 2013;368(2):100-102. doi: 10.1056/NEJMp1212324.

13. Campbell AD, Godfryd A, Buys DR, Locher JL. Does participation in home-delivered meals programs improve outcomes for older adults? results of a systematic review. J Nutr Gerontol Geriatr. 2015;34(2):124-167. doi: 10.1080/21551197.2015.1038463.

14. Zhu H, An R. Impact of home-delivered meal programs on diet and nutrition among older adults: a review. Nutr Health. 2013;22(2):89-103. doi: 10.1177/0260106014537146.

15. Alvarez R, Ginsburg J, Grabowski J, Post S, Rosenberg W. The social work role in reducing 30-day readmissions: the effectiveness of the Bridge Model of transitional care. J Gerontol Soc Work. 2016;59(3):222-227. doi: 10.1080/01634372.2016.1195781.

16. Gottlieb LM, Garcia K, Wing H, Manchanda R. Clinical interventions addressing nonmedical health determinants in Medicaid managed care. Am J Manag Care. 2016;22(5):370-376. doi: 10.1007/s40471-014-0031-3.
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