Effect of Medically Tailored Meals on Clinical Outcomes in Recently Hospitalized High-Risk Adults - PubMed (original) (raw)

Randomized Controlled Trial

. 2022 Oct 1;60(10):750-758.

doi: 10.1097/MLR.0000000000001759. Epub 2022 Aug 15.

Alan S Go 1 2 3 4, Kate M Horiuchi 1, Denise Laws 5, Andrew P Ambrosy 1 2 6, Keane K Lee 1 7, Benjamin L Maring 8, Jena Joy 8, Cathryn Couch 9, Paul Hepfer 10, Joan C Lo 1 2 11, Rishi V Parikh 1; KP NOURISH Study Investigators

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Randomized Controlled Trial

Effect of Medically Tailored Meals on Clinical Outcomes in Recently Hospitalized High-Risk Adults

Alan S Go et al. Med Care. 2022.

Abstract

Background: Inability to adhere to nutritional recommendations is common and linked to worse outcomes in patients with nutrition-sensitive conditions.

Objectives: The purpose of this study is to evaluate whether medically tailored meals (MTMs) improve outcomes in recently discharged adults with nutrition-sensitive conditions compared with usual care.

Research design: Remote pragmatic randomized trial.

Subjects: Adults with heart failure, diabetes, or chronic kidney disease being discharged home between April 27, 2020, and June 9, 2021, from 5 hospitals within an integrated health care delivery system.

Measures: Participants were prerandomized to 10 weeks of MTMs (with or without virtual nutritional counseling) compared with usual care. The primary outcome was all-cause hospitalization within 90 days after discharge. Exploratory outcomes included all-cause and cause-specific health care utilization and all-cause death within 90 days after discharge.

Results: A total of 1977 participants (MTMs: n=993, with 497 assigned to also receive virtual nutritional counseling; usual care: n=984) were enrolled. Compared with usual care, MTMs did not reduce all-cause hospitalization at 90 days after discharge [adjusted hazard ratio, aHR: 1.02, 95% confidence interval (CI), 0.86-1.21]. In exploratory analyses, MTMs were associated with lower mortality (aHR: 0.65, 95% CI, 0.43-0.98) and fewer hospitalizations for heart failure (aHR: 0.53, 95% CI, 0.33-0.88), but not for any emergency department visits (aHR: 0.95, 95% CI, 0.78-1.15) or diabetes-related hospitalizations (aHR: 0.75, 95% CI, 0.31-1.82). No additional benefit was observed with virtual nutritional counseling.

Conclusions: Provision of MTMs after discharge did not reduce risk of all-cause hospitalization in adults with nutrition-sensitive conditions. Additional large-scale randomized controlled trials are needed to definitively determine the impact of MTMs on survival and cause-specific health care utilization in at-risk individuals.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1

FIGURE 1

Randomization, enrollment, and treatment.

FIGURE 2

FIGURE 2

Cumulative incidence curves of primary and secondary outcomes.

References

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