Abstract
AbstractHome-delivered meals program has shown great promises in overcoming nutritional challenges for homebound adults facing food insecurity and/or at risk of diabetes. Nutrition-counseling provides knowledge and skills for diabetes management. The purpose of this study was to identify the impact of a nutrition-counseling program with home-delivered meals (HDM), on use of hospital services, before and after receiving services for 6 months. This study includes 2,440 clients, at risk of diabetes, enrolled in either HDM service only (n=1,099) or HDM and nutrition-counseling program (n=1,341) at a Meals on Wheels organization in Fort-Worth, Texas. Hospital service data was extracted from a regional claims database. Analysis of covariance and generalized estimating equations with Poisson distribution were performed to compare program effectiveness on utilization of hospital services between two groups. The average number of emergency room (ER) visits decreased from 1.15 to .75 and from .83 to .62 for HDM group and HDM and counseling group, respectively (F=20.67, p<.001). The average number of hospitalizations decreased from .52 to .26 and from .46 to .30 for HDM group and HDM and counseling group, respectively (F=29.05, p<.001). At completion of 6 months service, both groups were less likely to experience ER visits and hospitalizations after adjusting age, sex, race/ethnicity, and weekly number of meals. However, HDM and counseling group showed significantly less ER visits than HDM group. The findings of this study indicate that a structured nutritional-counseling program with HDM may contribute to reducing healthcare utilization for older adults with challenges of diabetes and food insecurity.
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