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    1 Comment for this article
    Trail Head Study
    Paul Nelson, M.D., M.S. | Family Health Care, P.C. retired

    I have three questions. How was the underlying schedule of the 10 weekly meals determined? When the meals were delivered, how were the delivery times arranged? What percentage of the participants in the study had a committed living partner?

    The results remind me of the benefits of supportive housing for high-risk, chronically homeless individuals. Congratulations to Doctor Berkowitz and his associates. Just over two years of sleepless nights, I presume.
    CONFLICT OF INTEREST: None Reported
    Original Investigation
    April 22, 2019

    Association Between Receipt of a Medically Tailored Meal Program and Health Care Use

    Author Affiliations
    • 1Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
    • 2Center for Health Equity Research, Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill
    • 3Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
    • 4Division of General Internal Medicine, Massachusetts General Hospital, Boston
    • 5Community Servings, Inc, Boston, Massachusetts
    • 6Massachusetts Department of Public Health, Boston
    • 7Mongan Institute, Massachusetts General Hospital, Boston
    • 8Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
    JAMA Intern Med. 2019;179(6):786-793. doi:10.1001/jamainternmed.2019.0198
    Key Points

    Question  Is participating in a medically tailored meal delivery program for medically and socially complex adults associated with fewer inpatient admissions?

    Findings  In this cohort study of 1020 adults that used a combined instrumental variable analysis and matching approach, participation in a medically tailored meal delivery program was associated with approximately half the number of inpatient admissions.

    Meaning  For medically and socially complex adults, participating in a medically tailored meal delivery program may reduce inpatient admissions, although cautious interpretation is warranted because intervention receipt was not randomized.

    Abstract

    Importance  Whether interventions to improve food access can reduce health care use is unknown.

    Objective  To determine whether participation in a medically tailored meal intervention is associated with fewer subsequent hospitalizations.

    Design, Setting, and Participants  A retrospective cohort study was conducted using near/far matching instrumental variable analysis. Data from the 2011-2015 Massachusetts All-Payer Claims database and Community Servings, a not-for-profit organization delivering medically tailored meals (MTMs), were linked. The study was conducted from December 15, 2016, to January 16, 2019. Recipients of MTMs who had at least 360 days of preintervention claims data were matched to nonrecipients on the basis of demographic, clinical, and neighborhood characteristics.

    Interventions  Weekly delivery of 10 ready-to-consume meals tailored to the specific medical needs of the individual under the supervision of a registered dietitian nutritionist.

    Main Outcomes and Measures  Inpatient admissions were the primary outcome. Secondary outcomes were admission to a skilled nursing facility and health care costs (from medical and pharmaceutical claims).

    Results  There were 807 eligible MTM recipients. After matching, there were 499 MTM recipients, matched to 521 nonrecipients for a total of 1020 study participants (mean [SD] age, 52.7 [14.5] years; 568 [55.7%] female). Prior to matching and compared with nonrecipients in the same area, health care use, health care cost, and comorbidity were all significantly higher in recipients. For example, preintervention mean (SD) inpatient admissions were 1.6 (6.5) in MTM recipients vs 0.2 (0.8) in nonrecipients (P < .001), and mean health care costs were $80 617 ($312 337) vs $16 138 ($68 738) (P < .001). Recipients compared with nonrecipients were also significantly more likely to have HIV (21.9% vs 0.7%, P < .001), cancer (37.9% vs 11.3%, P < .001), and diabetes (33.7% vs 7.0%, P < .001). In instrumental variable analyses, MTM receipt was associated with significantly fewer inpatient admissions (incidence rate ratio [IRR], 0.51; 95% CI, 0.22-0.80; risk difference, −519; 95% CI, −360 to −678 per 1000 person-years). Similarly, MTM receipt was associated with fewer skilled nursing facility admissions (IRR, 0.28; 95% CI, 0.01-0.60; risk difference, −913; 95% CI, −689 to −1457 per 1000 person-years). The models estimated that, had everyone in the matched cohort received treatment owing to the instrument (and including the cost of program participation), mean monthly costs would have been $3838 vs $4591 if no one had received treatment owing to the instrument (difference, −$753; 95% CI, −$1225 to −$280).

    Conclusions and Relevance  Participation in a medically tailored meals program appears to be associated with fewer hospital and skilled nursing admissions and less overall medical spending.

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