meals matter: a trial of medically tailored meals 2 weeks vs. 4 weeks post hospital discharge

Conditions: Heart Failure; Copd; Liver Failure; Diabetes Mellitus; Cancer; End Stage Renal Disease

Summary: the purpose of this study is to determine if medically tailored meals provided for either 2 weeks or 4 weeks (1 meal per day) to a kaiser permanente colorado (kpco) member after hospital discharge will improve their health. medically tailored meals (mtm) are meals that are approved by a dietitian and shown to help people with certain health conditions.

the purpose of this study is to determine if medically tailored meals provided for either 2 weeks or 4 weeks (1 meal per day) to a kaiser permanente colorado (kpco) member after hospital discharge will improve their health. medically tailored meals (mtm) are meals that are approved by a dietitian and shown to help people with certain health conditions. the investigators propose a research study with four specific aims: specific aim 1: to determine if mtm provided post hospitalization for 4 weeks to patients with one or more of seven chronic health conditions will decrease depression/anxiety measured by the hospital anxiety and depression scale (hads) at 60 days in comparison to meals provided for 2 weeks to members discharged from two hospitals. hypothesis 1: patients receiving meals for 4 weeks will have a clinically significant increase in their hads score at 60 days compared to those receiving meals for 2 weeks. specific aim 2: to determine if mtm provided for 4 weeks to patients with one or more of seven chronic health conditions post hospitalization will improve general well-being and functional status measured by katz's activities of daily living (adl). hypothesis 2: patients receiving meals for 4 weeks will have a clinically significant increase in their sense of well-being and adls at 60 days compared to those receiving meals for 2 weeks. specific aim 3: to determine if mtm provided for 4 weeks to patients with one or more of seven chronic health conditions post hospitalization will decrease a composite outcome of rehospitalizations and emergency department (ed) visits at 60 days in comparison to: a) meals provided for 2 weeks to members discharged from two hospitals; and b) a concurrent prospective control group not receiving meals at two other kpco-contracted hospitals. hypothesis 3: patients receiving meals for 4 weeks will have a decreased composite rate of rehospitalizations and ed visits at 60 days compared to those receiving meals for 2 weeks or the non-randomized control group. specific aim 4: to determine the feasibility, acceptability and scalability of the meals matter program to kp members, their households, and hospital leadership and staff.

Eligibility criteria:
inclusion criteria: * age 18 or older, with no upper age limit * hospitalized at saint joseph hospital or good samaritan medical center with the anticipation that they will be discharged home * member of a kp health plan * have one or more of the following conditions: * heart failure * cancer * end-stage renal disease (esrd)/chronic renal disease * chronic obstructive pulmonary disease (copd) * diabetes mellitus * chronic liver disease/cirrhosis exclusion criteria: * patient discharged to a nursing home, an assisted living facility, or another setting where meals are institutionally provided * patient has a health condition which is incompatible with the diet choices offered by project angel heart (pah - food service vendor) * patient refuses the type of meal best for their medical condition * patient has dementia * patient is pregnant or hospitalized peri-partum * patient is an active participant in a pah program or another meal program * patient is unable to speak english or spanish * pah unable to deliver meals due to patient not being in pah service area * patient was discharged from the hospital within 24 hours of admission * patient whose household member has enrolled in the meals matter study * patient discharged to hospice care

Keywords: medically tailored meals chronic conditions food service