Post-hospitalization home-delivered meal program associated with reduced mortality

Key takeaways:

• A 4-week post-hospitalization home-delivered meal benefit program was associated with lower 30-day rehospitalization and mortality.
• The positive associations persisted for 60 days.

A post-hospitalization home-delivered meal program was linked to lower 30-day mortality and rehospitalization, according to the results of research published in JAMA Health Forum.

The Chronic Care Act of 2018 granted Medicare Advantage (MA) plans more flexibility in offering supplemental benefits like transportation, meals and in-home services to fill gaps in care of beneficiaries with certain chronic conditions, Huong Q. Nguyen, PhD, RN, a nurse and health services researcher at Kaiser Permanente, and colleagues wrote.

Nearly three-quarters of MA plans offered meals as a supplemental benefit in 2022, “mostly driven by expectations of downstream cost savings” based on the results of previous observational studies evaluating community-based nutrition programs “and desires to maintain market parity in an increasingly competitive MA space,” the researchers wrote.

In 2021, Kaiser Permanente Southern California (KPSC) began offering two home-delivered meals per day for eligible members — mostly those hospitalized for heart failure (HF). KPSC also offers “a more generous buy-up meals benefit” of three meals per day to a subset of members covered under select employer group plans for any hospitalized condition, the Nguyen and colleagues wrote.

“HF was considered a nutrition-sensitive condition, and as such, patients could potentially benefit clinically from receiving convenient nutritional support during a vulnerable period after hospital discharge,” they wrote.

The researchers conducted a cohort study to assess the impact of a 4-week post-hospitalization home-delivered meals benefit program on 30-day all-cause rehospitalization and death among patients admitted for HF and all other acute medical conditions (non-HF).

They compared the outcomes of patients who received meals with two controls: the no meals-2019 group, representing those who had no meals in the 2019 historical cohort and would have been eligible for the benefit, and the no-meals-2021/2022 group, representing those who had no meals in the 2021 and 2022 concurrent cohort and were referred but did not receive any meals because of declines or unsuccessful contacts.

The final analysis included 7,944 adults with non-HF admissions to the hospital and 4,032 adults with admission to the hospital for HF.

Nguyen and colleagues found that in the non-HF group, the unadjusted rates for 30-day mortality and rehospitalization for the meals, no meals-2019 and no meals-2021/2022 cohorts were 16.5%, 22.4% and 32.9%, respectively. Meanwhile, the rates for the HF group were 23.3%, 30.1% and 38.5%.

For non-HF, the meal delivery program was linked to significantly lower odds of 30-day rehospitalization and mortality compared with the no meals-2019 (OR = 0.64; 95% CI, 0.52-0.79) and no meals-2021/2022 (OR = 0.48; 95% CI, 0.37-0.62) cohorts.

For HF, the program was significantly linked to lower odds of 30-day rehospitalization and mortality compared with the no meals-2021/2022 cohort (OR = 0.55; 95% CI, 0.43-0.71). However, it was not significant when compared with the no meals-2019 cohort (OR = 0.86; 95% CI, 0.72-1.04).

The researchers emphasized that the findings need to be confirmed by randomized clinical trials.

“While this home-delivered meals benefit was intended to be a short-term bridge for patients during a vulnerable period after discharge from the hospital, it was encouraging to see this association persisting into the 60-day period, especially for the non-HF cohort,” Nguyen and colleagues wrote. “It is unclear if the more robust outcomes observed in the non-HF vs. the HF cohort were due to the larger number of meals (84 vs. 56), a reflection of the clinical conditions that are more amenable to nutritional support, or some other factors.”