Association Between Receipt of a Medically Tailored Meal Program and Health Care Use
Association Between Receipt of a Medically Tailored Meal Program and Health Care Use
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DOI：
10.1001/jamainternmed.2019.0198
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发表时间：
2019-06-01
影响因子：
39
通讯作者：
Hsu, John
中科院分区：
文献类型：
--
作者：
Berkowitz, Seth A.;Terranova, Jean;Hsu, John
重要性
改善食物获取途径的干预措施是否能减少医疗保健的使用尚不明确。
目的
确定参与医学定制膳食干预是否与随后较少的住院次数相关。
设计、环境和参与者
采用近/远匹配工具变量分析进行了一项回顾性队列研究。将2011 - 2015年马萨诸塞州全支付者索赔数据库的数据与社区服务机构（一家提供医学定制膳食的非营利组织）的数据相关联。该研究于2016年12月15日至2019年1月16日进行。具有至少360天干预前索赔数据的医学定制膳食接受者根据人口统计学、临床和社区特征与未接受者进行匹配。
干预措施
在注册营养师的监督下，每周提供10份根据个人特定医疗需求定制的即食膳食。
主要结果和测量指标
住院是主要结果。次要结果是入住专业护理机构和医疗保健费用（来自医疗和药品索赔）。
结果
有807名符合条件的医学定制膳食接受者。匹配后，有499名医学定制膳食接受者与521名未接受者匹配，总共有1020名研究参与者（平均[标准差]年龄为52.7[14.5]岁；568人[55.7%]为女性）。在匹配之前，与同一地区的未接受者相比，接受者的医疗保健使用、医疗保健费用和合并症都显著更高。例如，干预前医学定制膳食接受者的平均（标准差）住院次数为1.6（6.5），而未接受者为0.2（0.8）（P<...此处原文似乎不完整）
ImportanceWhether interventions to improve food access can reduce health care use is unknown. ObjectiveTo determine whether participation in a medically tailored meal intervention is associated with fewer subsequent hospitalizations. Design, Setting, and ParticipantsA 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. InterventionsWeekly 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 MeasuresInpatient admissions were the primary outcome. Secondary outcomes were admission to a skilled nursing facility and health care costs (from medical and pharmaceutical claims). ResultsThere 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