Together in Care: An Enhanced Meals on Wheels Intervention Designed to Reduce Rehospitalizations among Older Adults with Cardiopulmonary Disease-Preliminary Findings.

Panagis Galiatsatos,Joyce Maygers,Lucy Theilheimer,Stephanie Archer Smith,William Daniel Hale,Richard G Bennett,Sherita H Golden,Adejoke Ajayi

doi:10.3390/ijerph19010458

Abstract

Rehospitalizations in the Medicare population may be influenced by many diverse social factors, such as, but not limited to, access to food, social isolation, and housing safety. Rehospitalizations result in significant cost in this population, with an expected increase as Medicare enrollment grows. We designed a pilot study based upon a partnership between a hospital and a local Meals on Wheels agency to support patients following an incident hospitalization to assess impact on hospital utilization. Patients from an urban medical center who were 60 years or older, had a prior hospitalization in the past 12 months, and had a diagnosis of diabetes, hypertension, heart failure, and/or chronic obstructive pulmonary disease were recruited. Meals on Wheels provided interventions over 3 months of the patient’s transition to home: food delivery, home safety inspection, social engagement, and medical supply allocation. Primary outcome was reduction of hospital expenditure. In regard to the results, 84 participants were included in the pilot cohort, with the majority (54) having COPD. Mean age was 74.9 ± 10.5 years; 33 (39.3%) were female; 62 (73.8%) resided in extreme socioeconomically disadvantaged neighborhoods. Total hospital expenditures while the cohort was enrolled in the transition program were $435,258 ± 113,423, a decrease as compared to $1,445,637 ± 325,433 (p < 0.01) of the cohort’s cost during the three months prior to enrollment. In conclusion, the initiative for patients with advanced chronic diseases resulted in a significant reduction of hospitalization expenditures. Further investigations are necessary to define the impact of this intervention on a larger cohort of patients as well as its generalizability across diverse geographic regions.

Highlights

This article is an open access articleOver the last several decades, the burden of disease has shifted from acute care toward chronic illness management [1]
Patients had primary admissions based on one of four common diseases that result in frequent rehospitalizations [11]: heart failure, diabetes, hypertension, and/or chronic obstructive pulmonary disease
In regard to the socioeconomic status, the majority of patients resided in disadvantaged neighborhoods, as identified by the area deprivation index, with a mean 78.2 ± 17.2

Summary

Introduction

This article is an open access article. Over the last several decades, the burden of disease has shifted from acute care toward chronic illness management [1]. The impact of this shift is seen in healthcare costs, which have continued to rise over recent years, and in medical care, which is becoming more complex, especially for older adults [2,3,4,5]. Older adults have an increased need for health information and resources to manage their health, health services, and overall wellness. Distributed under the terms and conditions of the Creative Commons.

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